Healthcare Provider Details

I. General information

NPI: 1861682064
Provider Name (Legal Business Name): CANDII HOMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WARSAW ROAD
CLINTON NC
28328-3518
US

IV. Provider business mailing address

100 WARSAW ROAD
CLINTON NC
28328-3518
US

V. Phone/Fax

Practice location:
  • Phone: 910-592-7451
  • Fax: 910-221-5479
Mailing address:
  • Phone: 910-592-7451
  • Fax: 910-221-5479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-082-056
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL-082056
License Number StateNC

VIII. Authorized Official

Name: MS. ROSALINA TEEL
Title or Position: PROVIDER
Credential: MHL082056
Phone: 910-592-7451