Organization
LAI GROUP HOMES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN LONG (OWNER)
(910) 794-8104
Entity
Organization
Contact information
Practice address
1022 BRICK LANDING RD SW, SHALLOTTE, NC 28470-5358
(910) 755-6713
Mailing address
PO BOX 10244, WILMINGTON, NC 28404-0244
(910) 794-8104
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-010-042
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-010-044
NC
Other
Enumeration date
12/19/2006
Last updated
08/22/2020
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