Organization
COLTRANES GROUP HOME
Active
Parent organization
COLTRANES GROUP HOME
Organization subpart
Yes
Provider details
NPI number
Legal business name
COLTRANES GROUP HOME
Authorized official
MS. LATHAY LORRAINE COLTRANE (OWNER/OPERATOR)
(336) 299-9757
Entity
Organization
Contact information
Practice address
3811 REPON ST, GREENSBORO, NC 27407-5536
(336) 299-9757
(336) 299-1419
Mailing address
PO BOX 79113, GREENSBORO, NC 27417-9113
(336) 299-9757
(336) 299-1419
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL-041-620
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408773
—
NC
05
—
7804354
—
NC
Enumeration date
09/11/2007
Last updated
09/11/2007
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