Individual
MRS. EMMA LUCILLE GARVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ADMINISTRATOR
Contact information
Practice address
4527 COUNTRY CLUB RD, WINSTON SALEM, NC 27104-3517
(336) 765-8460
(336) 724-9674
Mailing address
1161 EDENWOOD DR, WINSTON SALEM, NC 27103-6114
(336) 682-5870
(336) 724-9674
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
MHL 034-190
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805234
—
NC
Enumeration date
03/20/2007
Last updated
07/09/2007
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