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Individual

MR. ESTELLA JOANN SPANN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1136 BERTHA WILSON RD, BLANCH, NC 27212-9795
(336) 694-1878
(336) 694-1878
Mailing address
1136 BERTHA WILSON RD, BLANCH, NC 27212-9795
(336) 694-1878
(336) 694-1878

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
017058
NC
3104A0625X
Assisted Living Facility (Mental Illness)
017058
NM
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
017058
NC
310500000X
Mental Illness Intermediate Care Facility
017058
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
017058
FACILITY LICENSE NUMBER
NC
Enumeration date
02/08/2022
Last updated
02/08/2022
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