Organization
DICKENS GROUP HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEROME DICKENS (EXECUTIVE DIRECTOR)
(704) 906-1519
Entity
Organization
Contact information
Practice address
10719 STARWOOD AVE, CHARLOTTE, NC 28215-9587
(704) 906-1519
(704) 573-9407
Mailing address
10719 STARWOOD AVE, CHARLOTTE, NC 28215-9587
(704) 906-1519
(704) 573-9407
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/14/2008
Last updated
07/14/2008
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