Healthcare Provider Details

I. General information

NPI: 1407973068
Provider Name (Legal Business Name): JOSIE S. DALTON DBA ALMA'S HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 SHIRLEY LN
GREENSBORO NC
27401-4733
US

IV. Provider business mailing address

710 W TERRELL ST
GREENSBORO NC
27406-2748
US

V. Phone/Fax

Practice location:
  • Phone: 336-965-0577
  • Fax: 336-370-4822
Mailing address:
  • Phone: 336-965-0577
  • Fax: 336-370-4822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMHL-041-778
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DONNETTA R DALTON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 336-965-0577