Healthcare Provider Details

I. General information

NPI: 1992902373
Provider Name (Legal Business Name): THE SERVANT CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 08/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 LEXINGTON AVE
GREENSBORO NC
27403-3507
US

IV. Provider business mailing address

1312 LEXINGTON AVE
GREENSBORO NC
27403-3507
US

V. Phone/Fax

Practice location:
  • Phone: 336-275-8585
  • Fax: 336-370-1540
Mailing address:
  • Phone: 336-275-8585
  • Fax: 336-370-1540

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 Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. GAIL HAWORTH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-275-8585