Organization
WICKER STREET GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DOROTHEA VIVIAN ROGERS (DIRECTOR/OWNER)
(336) 578-0004
Entity
Organization
Contact information
Practice address
1620 FLORA AVE, BURLINGTON, NC 27217-1018
(336) 227-4350
(336) 227-4350
Mailing address
PO BOX 981, HAW RIVER, NC 27258-0981
(336) 578-0004
(336) 227-4350
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
001-217
NC
Other
Enumeration date
07/19/2011
Last updated
02/12/2025
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