Healthcare Provider Details

I. General information

NPI: 1144404377
Provider Name (Legal Business Name): THE R. A. GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 12/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 E 6TH ST
BURLINGTON NC
27215-5730
US

IV. Provider business mailing address

PO BOX 2828
BURLINGTON NC
27216-2828
US

V. Phone/Fax

Practice location:
  • Phone: 336-229-0883
  • Fax:
Mailing address:
  • Phone: 336-229-0883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCL-001-123
License Number StateNC

VIII. Authorized Official

Name: MRS. ADA EVELYN LOVE
Title or Position: ADMINISTRATOR
Credential:
Phone: 336-229-0883