Organization
LORD IS THE LIGHT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIMBERLY MICHELLE FOUST (OWNER)
(336) 213-5830
Entity
Organization
Contact information
Practice address
2802 ELDERMONT ST, APT E, BURLINGTON, NC 27215-6111
(336) 270-6217
Mailing address
2802 ELDERMONT ST, APT E, BURLINGTON, NC 27215-6111
(336) 270-6217
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-001-196
NC
Other
Enumeration date
07/08/2010
Last updated
07/08/2010
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