Healthcare Provider Details

I. General information

NPI: 1164574471
Provider Name (Legal Business Name): SPECIAL SERVICES OF THE PIEDMONT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 CEDROW DR
HIGH POINT NC
27260-3701
US

IV. Provider business mailing address

4017 MAID MARION CT
JAMESTOWN NC
27282-7705
US

V. Phone/Fax

Practice location:
  • Phone: 336-884-5544
  • Fax: 336-884-5544
Mailing address:
  • Phone: 336-454-5295
  • Fax: 336-454-5295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL-041-755
License Number StateNC

VIII. Authorized Official

Name: MS. VERTHA L LEACH
Title or Position: DIRECTOR
Credential:
Phone: 336-454-5295