Healthcare Provider Details

I. General information

NPI: 1851617690
Provider Name (Legal Business Name): SPECIAL K SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NESTLEWAY DR
GREENSBORO NC
27406-8237
US

IV. Provider business mailing address

825 NESTLEWAY DR
GREENSBORO NC
27406-8237
US

V. Phone/Fax

Practice location:
  • Phone: 336-275-4594
  • Fax: 336-275-6825
Mailing address:
  • Phone: 336-275-4594
  • Fax: 336-275-6825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-041-770
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMHL-041-770
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-041-770
License Number StateNC

VIII. Authorized Official

Name: MS. JOYCE MCEACHIRN
Title or Position: CEO
Credential:
Phone: 336-312-1316