Organization
G & D RESIDENTIAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEOVON KENANE MARTIN B.A. (CEO DIRECTOR)
(336) 254-6770
Entity
Organization
Contact information
Practice address
1208 SLOAN ST, GREENSBORO, NC 27401-3442
(336) 254-6770
(336) 272-8083
Mailing address
800 SPRUILL CT, SUITE E, GREENSBORO, NC 27409-3042
(336) 254-6770
(336) 272-8083
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL-041-764
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300792H
—
NC
Enumeration date
06/21/2007
Last updated
06/30/2008
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