Organization
GREATER IMAGE HC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RODNEY L JOHNSON (CEO)
(910) 321-0069
Entity
Organization
Contact information
Practice address
1112 DEVONSHIRE TRL, ABERDEEN, NC 28315-3910
(910) 944-1674
Mailing address
401 ROBESON STREET, FAYETTEVILLE, NC 28301
(910) 321-0069
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-063-105
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1326476383
NPI
—
Enumeration date
10/29/2013
Last updated
07/15/2020
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