Healthcare Provider Details

I. General information

NPI: 1144515032
Provider Name (Legal Business Name): HLEE PROGRAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2011
Last Update Date: 06/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LOMBARDY ST
GREENSBORO NC
27405-6016
US

IV. Provider business mailing address

PO BOX 393
REIDSVILLE NC
27323-0393
US

V. Phone/Fax

Practice location:
  • Phone: 336-634-0964
  • Fax:
Mailing address:
  • Phone: 336-634-0964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. BROUGHTON LEEVANUAL MILES
Title or Position: BOARD MEMBER
Credential:
Phone: 336-634-0964