Organization
DFM INCORPORTATED ADOLESCENT HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TIFFANY DELORSE MONROE BS (CEO)
(910) 273-5473
Entity
Organization
Contact information
Practice address
3999 FAYETTEVILLE RD, RAEFORD, NC 28376-8059
(910) 273-5473
(919) 498-0874
Mailing address
7735 S SHIELD DR, FAYETTEVILLE, NC 28314-6352
(910) 273-5473
(919) 498-0874
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-047-112
NC
Other
Enumeration date
04/01/2009
Last updated
04/01/2009
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