Organization
UNION AVENUE GROUP HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL MCMILLAN (DIRETOR)
(336) 404-2003
Entity
Organization
Contact information
Practice address
210 UNION AVE, BURLINGTON, NC 27217-2442
(336) 404-2003
(336) 226-5097
Mailing address
PO BOX 1108, GREENSBORO, NC 27402-1108
(336) 404-2003
(336) 226-5097
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL-001-174
NC
Other
Enumeration date
06/09/2009
Last updated
06/09/2009
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