Healthcare Provider Details

I. General information

NPI: 1124887344
Provider Name (Legal Business Name): STRAIGHT TALK SUPPORT GROUP TRANSITIONAL HOUSE RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N MANGUM ST
DURHAM NC
27701-1931
US

IV. Provider business mailing address

1101 N MANGUM ST
DURHAM NC
27701-1931
US

V. Phone/Fax

Practice location:
  • Phone: 984-219-1001
  • Fax: 984-219-1637
Mailing address:
  • Phone: 984-219-1001
  • Fax: 984-219-1637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: BESSIE L ELMORE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 984-219-1001