Organization
BYNUM'S PLACE LLC
Active
Other names
Jeremiah's Place
Organization subpart
No
Provider details
NPI number
Authorized official
MOORE BYNUM (OWNER)
(252) 915-9174
Entity
Organization
Contact information
Practice address
1455 BULLOCKSVILLE ROAD, MANSON, NC 27553-9765
(252) 456-6534
Mailing address
1455 BULLOCKSVILLE ROAD, MANSON, NC 27553-9765
(252) 456-6534
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL091077
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041247
FACILITY ID
NC
Enumeration date
02/14/2007
Last updated
08/22/2020
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