Organization
GODS PALACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN LEE PERRY (MEMBER/MANAGER)
(336) 729-5927
Entity
Organization
Contact information
Practice address
1925 ASTORIA CT, WINSTON SALEM, NC 27127-5834
(336) 729-5927
Mailing address
4030 WAKE FOREST RD STE 349, RALEIGH, NC 27609-0010
(336) 729-5927
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/15/2025
Last updated
10/15/2025
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