MEDICARE: ABS VALLEY OF HOPE PRTF, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1659147718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABS VALLEY OF HOPE PRTF, LLC

Provider Business Mailing Address
First Line	:	905 MCCLELLAN PL
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27409-8930
Country	:	US
Telephone Number	:	336-370-9400
Fax Number	:	336-373-0134

Provider Business Practice Location Address
First Line	:	2505 FAIRVIEW ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-4919
Country	:	US
Telephone Number	:	336-370-9400
Fax Number	:	336-373-0134

Authorized Official
Title or Position	:	CEO
Name	:	LUWANDA DENISE SMITH-DANIELS
Credential	:	RN
Telephone Number	:	336-370-9400

Provider Enumeration Date	:	11/30/2023
Last Update Date	:	11/30/2023

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