Healthcare Provider Details

I. General information

NPI: 1124306865
Provider Name (Legal Business Name): ADULT DAY&RESPITE CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3107 GROOMETOWN RD
GREENSBORO NC
27407-5518
US

IV. Provider business mailing address

3107 GROOMETOWN RD N/A
GREENSBORO NC
27407-5518
US

V. Phone/Fax

Practice location:
  • Phone: 336-852-8338
  • Fax: 336-852-8333
Mailing address:
  • Phone: 336-852-8338
  • Fax: 336-852-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMHL-076-099
License Number StateNC

VIII. Authorized Official

Name: JOANNE CAGLE
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 336-852-8338