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Organization

LINDA SHORTS HOME

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. LINDA E GIBSON (DIRECTOR)
(910) 455-6724
Entity
Organization

Contact information

Practice address
106 GRANTHAM LN, JACKSONVILLE, NC 28546-8150
(910) 455-4480
Mailing address
180 COASTAL LN, JACKSONVILLE, NC 28546-6761
(910) 455-6724
(910) 346-5489

Taxonomy

Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
MHL067026
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
MHL067026
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3408956
NC
Enumeration date
12/29/2006
Last updated
06/24/2015
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