Organization
WILLOW ROAD FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CORNELIUS WILLIAMS (OWNER)
(252) 257-1814
Entity
Organization
Contact information
Practice address
474 MACON EMBRO RD, MACON, NC 27551-9285
(252) 257-1814
Mailing address
474 MACON EMBRO RD, MACON, NC 27551-9285
(252) 257-1814
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-093-034
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3418365
—
NC
05
—
7804755
—
NC
Enumeration date
01/29/2008
Last updated
01/29/2008
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