Organization
EDWARDS GROUP HOME 3
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS MCCOLLUM (CEO)
(252) 747-4000
Entity
Organization
Contact information
Practice address
1233 APPLETREE ROAD, STANTONSBURG, NC 27833
(252) 747-4000
(252) 747-2602
Mailing address
PO BOX 295, SNOW HILL, NC 28580-0295
(252) 747-4000
(252) 747-2602
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL040026
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7805043
PROVIDER NUMBER
NC
Enumeration date
03/07/2007
Last updated
01/10/2008
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