Organization
IT TAKES A VILLAGE RESIDENTIAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAQUILLE JACKSON (CEO)
(336) 608-2819
Entity
Organization
Contact information
Practice address
5008 BUTTERFIELD DR, WINSTON SALEM, NC 27105-3344
(336) 608-2819
Mailing address
5008 BUTTERFIELD DR, WINSTON SALEM, NC 27105-3344
(336) 608-2819
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NA
—
NC
Enumeration date
02/17/2020
Last updated
02/17/2020
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