Organization
EXTENDED FAMILY RESIDENCES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATOYIA ROBERTS (CEO)
(614) 804-6049
Entity
Organization
Contact information
Practice address
7330 CLAIBORNE WOODS RD, CHARLOTTE, NC 28216-5779
(614) 804-6049
Mailing address
7330 CLAIBORNE WOODS RD, CHARLOTTE, NC 28216-5779
(980) 209-9987
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
07/15/2022
Last updated
07/24/2024
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