Organization
ABUNDANCE OF FAITH X 5
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATOYA LENORE THURSTON-GRIGGS (MANAGER)
(336) 432-7141
Entity
Organization
Contact information
Practice address
301 WENTWORTH ST, REIDSVILLE, NC 27320-2231
(336) 432-7141
Mailing address
301 WENTWORTH ST, REIDSVILLE, NC 27320-2231
(336) 432-7141
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
FCL-079-056
NC
Other
Enumeration date
12/18/2012
Last updated
12/18/2012
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