Organization
NATIONAL MENTOR HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BONITA MCKOY (THERAPIST)
(336) 765-8912
Entity
Organization
Contact information
Practice address
7 OAK BRANCH DR STE C, GREENSBORO, NC 27407-2392
(336) 856-1140
Mailing address
7 OAK BRANCH DR STE C, GREENSBORO, NC 27407-2392
(336) 856-1140
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1041C0700X
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300268H
—
NC
Enumeration date
07/23/2010
Last updated
07/23/2010
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