Organization
JOHNSTON COUNTY INDUSTRIES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKI R SHORE (EXECUTIVE DIRECTOR)
(919) 743-8702
Entity
Organization
Contact information
Practice address
112 E RICHARDSON ST, SELMA, NC 27576-2606
(919) 965-6892
Mailing address
1100 E PRESTON ST, SELMA, NC 27576-3162
(919) 743-8709
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MHL-051-162
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8302099
—
NC
Enumeration date
04/08/2008
Last updated
08/26/2008
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