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Organization

LEE COUNTY GROUP HOME, INC.

Active
Other names
Lee #2
Organization subpart
No

Provider details

NPI number
Authorized official
JUDIETH AUTRY (GENERAL BOARD FINANCIAL)
(919) 770-5484
Entity
Organization

Contact information

Practice address
2412 KNOLLWOOD DR, LEE # 2, SANFORD, NC 27330-7671
(919) 776-9189
(919) 774-7711
Mailing address
PO BOX 1373, LEE # 2, SANFORD, NC 27331-1373
(919) 776-9189
(919) 774-7711

Taxonomy

Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL053041
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
780514
NC
Enumeration date
09/16/2006
Last updated
03/21/2025
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