Organization
J. L. REDFORD, INC.
Active
Organization
J. L. REDFORD, INC.
Active
Other names
J. L. Redford, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GLORIA R. FAULKNER MASTER'S DEGREE (OWNER/ADMINISTRATOR)
(336) 972-0531
Entity
Organization
Contact information
Practice address
1922 MARTIN LUTHER KING, JR. DRIVE, WINSTON SALEM, NC 27107-1361
(336) 972-0053
(336) 720-9521
Mailing address
1922 MARTIN LUTHER KING, JR. DRIVE, WINSTON SALEM, NC 27107-1361
(336) 972-0531
(336) 720-9521
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
4537
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3409110
—
NC
Enumeration date
08/22/2006
Last updated
10/06/2015
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