Healthcare Provider Details

I. General information

NPI: 1437005238
Provider Name (Legal Business Name): PIEDMONT HEALTHCARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 DELTA PL
GREENSBORO NC
27406-4906
US

IV. Provider business mailing address

2216 DELTA PL
GREENSBORO NC
27406-4906
US

V. Phone/Fax

Practice location:
  • Phone: 336-929-1231
  • Fax:
Mailing address:
  • Phone: 336-929-1231
  • Fax: 133-645-8953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRANDON LADELL WALLINGTON
Title or Position: OWNER ADMINISTRATOR
Credential:
Phone: 336-929-1231