Organization
KYSEEM'S UNITY GROUP HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEARL RAY POWELL (EXECUTIVE DIRECTOR)
(252) 902-7078
Entity
Organization
Contact information
Practice address
408 EAST TARBORO STREET, PINETOPS, NC 27864-2786
(252) 902-7078
(252) 756-8586
Mailing address
PO BOX 129, PINETOPS, NC 27864-0129
(252) 902-6277
(252) 758-1119
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MHL033076
NC
Other
Enumeration date
05/21/2010
Last updated
01/20/2022
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