Organization
HOUSE OF PHYLL EMPOWERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY LYNN GRAVES-WOODARD (CEO)
(336) 514-8252
Entity
Organization
Contact information
Practice address
425 S MAIN ST, ROXBORO, NC 27573-5527
(336) 514-8252
Mailing address
2586 NC HIGHWAY 57 N, MILTON, NC 27305-9312
(336) 514-8252
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/09/2023
Last updated
11/09/2023
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