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Organization

RUSSELL HOUSE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MAYNARD RUSSELL (DIRECTOR)
(336) 672-0169
Entity
Organization

Contact information

Practice address
1691 OLD BUFFALO FORD RD, ASHEBORO, NC 27205-7893
(336) 672-0169
(336) 672-0169
Mailing address
1691 OLD BUFFALO FORD RD, ASHEBORO, NC 27205-7893
(336) 672-0169
(336) 672-0169

Taxonomy

Speciality
Code
Description
License number
State
275N00000X
Medicare Defined Swing Bed Hospital Unit
NC
311ZA0620X
Adult Care Home Facility
Primary
MHL-076-108
NC
315P00000X
Intellectual Disabilities Intermediate Care Facility
MHL-076-108
NC

Other

Enumeration date
04/25/2012
Last updated
07/21/2022
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