Healthcare Provider Details

I. General information

NPI: 1669640967
Provider Name (Legal Business Name): LAMONTE D. DUNLAP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 GRAMERCY PARK DR
GREENSBORO NC
27406-8566
US

IV. Provider business mailing address

2013 GRAMERCY PARK DR
GREENSBORO NC
27406-8566
US

V. Phone/Fax

Practice location:
  • Phone: 336-587-1678
  • Fax:
Mailing address:
  • Phone: 336-587-1678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. LAMONTE DEWAYNE DUNLAP
Title or Position: OWNER
Credential:
Phone: 336-587-1678