Organization
CHESTNUT MANOR
Active
Organization
CHESTNUT MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. YOLANDA DENISE CHESTNUT (ADMINISTRAOR)
(919) 401-5781
Entity
Organization
Contact information
Practice address
2018 BIVINS ST, DURHAM, NC 27707-1404
(919) 401-5781
Mailing address
2018 BIVINS ST, DURHAM, NC 27707-1404
(919) 401-5781
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
032339
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805149
—
NC
Enumeration date
03/30/2007
Last updated
08/22/2020
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