Healthcare Provider Details

I. General information

NPI: 1285084889
Provider Name (Legal Business Name): SISTER'S HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 PEACHCROFT RD
CHARLOTTE NC
28216-2747
US

IV. Provider business mailing address

2512 ROBINWOOD AVE
TOLEDO OH
43610-1351
US

V. Phone/Fax

Practice location:
  • Phone: 419-508-6434
  • Fax:
Mailing address:
  • Phone: 419-508-6434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TYLISHA RILEY
Title or Position: CEO
Credential: MA
Phone: 419-508-6434