Organization
GRANDFATHER HOME COMMUNITY SERVICES FOR CHILDREN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIM SWINKOLA MBA, MSW (CEO)
(828) 898-5465
Entity
Organization
Contact information
Practice address
5560 STURMER PARK CIR, WINSTON SALEM, NC 27105-1372
(828) 898-5465
(828) 898-8513
Mailing address
PO BOX 98, BANNER ELK, NC 28604-0098
(828) 898-5465
(828) 898-8513
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL-034-015
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603668
—
NC
Enumeration date
01/02/2007
Last updated
02/22/2008
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