Organization
DWAYNE'S EXTENDED FAMILY SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DWAYNE TRIPP (OWNER)
(336) 638-3494
Entity
Organization
Contact information
Practice address
1421 WALNUT ST, GREENSBORO, NC 27405-6648
(336) 638-3494
(336) 638-3494
Mailing address
1215 BALES CHAPEL RD, JAMESTOWN, NC 27282-9149
(336) 638-3494
(336) 638-3494
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-041-627
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
MHL-041-676
NC
Other
Enumeration date
01/02/2007
Last updated
08/22/2020
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