Organization
UNIQUELY SUPPORTED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DANA HEAD (ADMINSTRATOR)
(828) 289-4333
Entity
Organization
Contact information
Practice address
2904 PHILADELPHIA RD, LAWNDALE, NC 28090-9461
(704) 538-3648
Mailing address
PO BOX 690, FALLSTON, NC 28042-0690
(704) 538-3648
(704) 538-6940
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805143
—
NC
05
—
7805267
—
NC
05
—
7805274
—
NC
05
—
7805275
—
NC
05
—
7805276
—
NC
05
—
7805278
—
NC
05
—
7805279
—
NC
05
—
7805295
—
NC
05
—
7805296
—
NC
05
—
7805316
—
NC
05
—
7805317
—
NC
05
—
7805318
—
NC
Enumeration date
01/30/2007
Last updated
08/22/2020
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