Healthcare Provider Details

I. General information

NPI: 1265598692
Provider Name (Legal Business Name): CANDII HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 02/20/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 RALEIGH RD, SUITE D 404 EAST POWELL ST
CLINTON NC
28328
US

IV. Provider business mailing address

404 EAST POWELL ST
CLINTON NC
28328-3518
US

V. Phone/Fax

Practice location:
  • Phone: 910-260-4195
  • Fax: 910-260-4195
Mailing address:
  • Phone: 910-627-4796
  • Fax: 910-260-4195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-085-056
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL-082-056
License Number StateNC

VIII. Authorized Official

Name: MRS. ROSALINA TEEL
Title or Position: PROVIDER/ADMINISTRATOR
Credential: MHL-082-056
Phone: 910-627-4796