Healthcare Provider Details

I. General information

NPI: 1598046013
Provider Name (Legal Business Name): SYLVANGLADE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WEST MEADOWVIEW ROAD 218,220,222,224
GREENSBORO NC
27407-3711
US

IV. Provider business mailing address

2300 WEST MEADOWVIEW ROAD 218,220,222,224
GREENSBORO NC
27407-3711
US

V. Phone/Fax

Practice location:
  • Phone: 336-450-7215
  • Fax: 336-450-2007
Mailing address:
  • Phone: 336-450-7215
  • Fax: 336-676-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL041929
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHERRILL KAYE DAVIS
Title or Position: DIRECTOR
Credential:
Phone: 336-218-1176