Organization
THE CHILDREN'S HOME, INC
Active
Other names
Tise Cottage
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEORGE M BRYAN (CEO/PRESIDENT)
(336) 721-7600
Entity
Organization
Contact information
Practice address
1001 REYNOLDA ROAD, WINSTON SALEM, NC 27104-3254
(336) 721-7600
(336) 728-4355
Mailing address
1001 REYNOLDA ROAD, WINSTON SALEM, NC 27104-3254
(336) 721-7600
(336) 728-4355
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL034242
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MHL034242
NC DHHS
NC
Enumeration date
06/08/2009
Last updated
06/08/2009
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