Healthcare Provider Details

I. General information

NPI: 1710026679
Provider Name (Legal Business Name): SIPES ORCHARD HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4431 COUNTY HOME RD
CONOVER NC
28613-9641
US

IV. Provider business mailing address

4431 COUNTY HOME RD
CONOVER NC
28613-9641
US

V. Phone/Fax

Practice location:
  • Phone: 828-256-5056
  • Fax: 828-256-4031
Mailing address:
  • Phone: 828-256-5056
  • Fax: 828-256-4031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-018065
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-018080
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-018063
License Number StateNC

VIII. Authorized Official

Name: MR. BRIAN L PHELPS
Title or Position: CEOPRESIDENT
Credential: ED.D
Phone: 828-256-5056