Organization
LAWRENCE EDWARD GRAHAM JR YOUTH OUTREACH FACILITY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RONDLA GRAHAM PHILLIP (OWNER, PRESIDENT, CEO)
(910) 964-5034
Entity
Organization
Contact information
Practice address
9431 NC HIGHWAY 211 W, RED SPRINGS, NC 28377-6001
(910) 843-5976
(910) 843-5976
Mailing address
PO BOX 1952, RAEFORD, NC 28376-3952
(910) 843-5976
(910) 843-5976
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL-078-201
NC
Other
Enumeration date
01/14/2008
Last updated
01/14/2008
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