Healthcare Provider Details

I. General information

NPI: 1417176991
Provider Name (Legal Business Name): LILY OF THE VALLEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4107 MAYNARD CIR
FRANKLINTON NC
27525-7576
US

IV. Provider business mailing address

4107 MAYNARD CIR
FRANKLINTON NC
27525-7576
US

V. Phone/Fax

Practice location:
  • Phone: 919-528-7285
  • Fax: 919-528-7285
Mailing address:
  • Phone: 919-528-7285
  • Fax: 919-528-7285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL-092660
License Number StateNC

VIII. Authorized Official

Name: MRS. CANDICE MORGAN SANFORD
Title or Position: OWNER
Credential:
Phone: 919-554-2221