Healthcare Provider Details

I. General information

NPI: 1235543802
Provider Name (Legal Business Name): RIKARDS RESIDENTIAL FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 DUNBAR ST
GREENSBORO NC
27401-3806
US

IV. Provider business mailing address

1628 DUNBAR ST
GREENSBORO NC
27401-3806
US

V. Phone/Fax

Practice location:
  • Phone: 336-772-2491
  • Fax: 336-373-3962
Mailing address:
  • Phone: 336-772-2491
  • Fax: 336-373-3962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNC

VIII. Authorized Official

Name: MARYANN MACK RIKARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 336-772-2491