Organization
CHURCH STREET GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MITTIE B FULLER (PRESIDENT/OWNER)
(336) 227-1613
Entity
Organization
Contact information
Practice address
1017 S CHURCH ST, BURLINGTON, NC 27215-5045
(336) 227-1613
(336) 227-1613
Mailing address
PO BOX 1996, BURLINGTON, NC 27216-1996
(336) 227-1613
(336) 227-1613
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
MHL-001-213
NC
Other
Enumeration date
04/27/2011
Last updated
04/27/2011
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