Organization
SPECIAL JEWEL GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALICE CLARK (OWNER)
(252) 446-6612
Entity
Organization
Contact information
Practice address
200 S TILLERY ST, ROCKY MOUNT, NC 27804-5527
(252) 446-6612
Mailing address
232 REGENCY DR, NASHVILLE, NC 27856-1812
(252) 446-6612
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL064102
NC
Other
Enumeration date
07/24/2009
Last updated
07/24/2009
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