Organization
LEVAN PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY PAUL (BOARD SECRETARY)
(336) 520-7687
Entity
Organization
Contact information
Practice address
4278 ASHLAND RD, REIDSVILLE, NC 27320-0509
(336) 520-7687
Mailing address
PO BOX 393, REIDSVILLE, NC 27323-0393
(336) 520-7687
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
311ZA0620X
Adult Care Home Facility
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
09/08/2009
Last updated
06/07/2010
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