Healthcare Provider Details

I. General information

NPI: 1255539235
Provider Name (Legal Business Name): CHILDRENS HOME SOCIETY OF NC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 MEADOW ST
GREENSBORO NC
27405-6600
US

IV. Provider business mailing address

PO BOX 14608
GREENSBORO NC
27415-4608
US

V. Phone/Fax

Practice location:
  • Phone: 336-274-1538
  • Fax: 336-274-7347
Mailing address:
  • Phone: 336-274-1538
  • Fax: 336-379-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number200501663
License Number StateNC

VIII. Authorized Official

Name: MR. KENNETH E TUTTEROW
Title or Position: PRESIDENT
Credential:
Phone: 336-274-1538