Healthcare Provider Details

I. General information

NPI: 1508729286
Provider Name (Legal Business Name): ROAD 2 REDEMPTION TRANSITIONAL HOUSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 HOLDERS RD
GREENSBORO NC
27405-2809
US

IV. Provider business mailing address

3130 EXACTA LN APT 904
RALEIGH NC
27613-8955
US

V. Phone/Fax

Practice location:
  • Phone: 919-928-1221
  • Fax:
Mailing address:
  • Phone: 919-928-1221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ERICA MADDOX
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-928-1221