Healthcare Provider Details

I. General information

NPI: 1124355698
Provider Name (Legal Business Name): SISTER TO SISTER 2, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 BOONES BRIDGE RD
COMO NC
27818-9502
US

IV. Provider business mailing address

350 BOONES BRIDGE RD
COMO NC
27818-9502
US

V. Phone/Fax

Practice location:
  • Phone: 252-398-5636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. PHYLLIS HILL MADRIC
Title or Position: CEO
Credential:
Phone: 252-398-5636