Organization
CHRISTOPHER'S KINGDOM INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CICLEY RENEE MALONE (FACILITY DIRECTOR)
(919) 522-9674
Entity
Organization
Contact information
Practice address
5703 BEACH WATER DR, #103, RALEIGH, NC 27604-8712
(919) 266-6969
(919) 266-6969
Mailing address
5703 BEACH WATER DR, #103, RALEIGH, NC 27604-8712
(919) 266-6969
(919) 266-6969
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NC
Other
Enumeration date
10/26/2007
Last updated
12/27/2007
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