Organization
FAIRLEY SUPPORT GROUP HOME INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TONY MELVIN FAIRLEY (ADMINISTRATOR/CEO)
(910) 844-1880
Entity
Organization
Contact information
Practice address
12519 US HWY 501 SOUTH, MAXTON, NC 28364
(910) 844-1880
(910) 844-1880
Mailing address
PO BOX 182, 12519 US HWY 501 SOUTH, MAXTON, NC 28364-0182
(910) 844-1880
(910) 844-1880
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-078-174
NC
Other
Enumeration date
08/20/2007
Last updated
08/20/2007
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