Organization
BLUE STATE WELLNESS AND RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON WILLIAMS (CHAIRMAN/MEMBER MANAGER)
(336) 287-1395
Entity
Organization
Contact information
Practice address
1930 LEGACY PARK, WINSTON SALEM, NC 27103-5838
(336) 287-1395
Mailing address
1930 LEGACY PARK, WINSTON SALEM, NC 27103-5838
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
174200000X
Meals Provider
—
—
177F00000X
Lodging Provider
—
—
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
02/23/2019
Last updated
02/23/2019
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