Organization
EXTENDED CARE SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIAN FOSTER JONES (OWNER/OPERATOR)
(919) 496-2958
Entity
Organization
Contact information
Practice address
1084 FULLER ROAD, LOUISBURG, NC 27549-7709
(919) 496-2958
Mailing address
1084 FULLER RD, LOUISBURG, NC 27549-7709
(919) 496-2958
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-035-017
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7803501
—
NC
Enumeration date
10/31/2007
Last updated
10/31/2007
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