Organization
ST.MARYSGROUPHOMESINC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUMOKA AYAANA MURRAY (FACILTY DIRECTOR)
(919) 363-1462
Entity
Organization
Contact information
Practice address
1071 PEMBERTON HILL RD, APEX, NC 27502-4268
(919) 363-1462
(919) 367-9474
Mailing address
1071 PEMBERTON HILL RD, APEX, NC 27502-4268
(919) 363-1462
(919) 367-9474
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
MHL-096-172
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805652
—
NC
Enumeration date
01/22/2007
Last updated
08/22/2020
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