Healthcare Provider Details

I. General information

NPI: 1679797443
Provider Name (Legal Business Name): POSITIVE FORCE OF NORTH CAROLINA CAM HOUSE1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 DELWIN CT
GREENSBORO NC
27406-5170
US

IV. Provider business mailing address

8 DELWIN CT
GREENSBORO NC
27406-5170
US

V. Phone/Fax

Practice location:
  • Phone: 336-274-1492
  • Fax: 336-274-1492
Mailing address:
  • Phone: 336-274-1492
  • Fax: 336-274-1492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL-041-700
License Number StateNC

VIII. Authorized Official

Name: MS. DANNAE LYNN WHITE
Title or Position: CEPO
Credential:
Phone: 336-274-1492