Organization
PIEDMONT PIONEER HOUSE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VONDA KAYE BURTON QMHP, QDDP (EXECUTIVE DIRECTOR)
(704) 884-2701
Entity
Organization
Contact information
Practice address
910 ROBERTS DR, GASTONIA, NC 28054-5804
(704) 884-2700
(704) 854-4234
Mailing address
910 ROBERTS DR, GASTONIA, NC 28054-5804
(704) 884-2700
(704) 854-4234
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL-036-004
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301292
—
NC
Enumeration date
12/22/2006
Last updated
06/18/2008
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