Organization
SOMMERVILLE GROUP SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH ASAH FON-NDIKUM (CO-FOUNDER)
(704) 219-6084
Entity
Organization
Contact information
Practice address
1017 WOODKIRK LN, MATTHEWS, NC 28104-8053
(704) 219-6084
Mailing address
1017 WOODKIRK LN, MATTHEWS, NC 28104-8053
(704) 219-6084
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
168913
NC
343900000X
Non-emergency Medical Transport (VAN)
168913
NC
Other
Enumeration date
04/01/2009
Last updated
04/01/2009
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