Healthcare Provider Details

I. General information

NPI: 1427341858
Provider Name (Legal Business Name): FLYING START CREATIVE EXPRESSIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 STERNLY WAY
HIGH POINT NC
27260-8498
US

IV. Provider business mailing address

1204 STERNLY WAY
HIGH POINT NC
27260-8498
US

V. Phone/Fax

Practice location:
  • Phone: 336-471-5973
  • Fax:
Mailing address:
  • Phone: 336-471-5973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL0411011
License Number StateNC

VIII. Authorized Official

Name: MS. SHENIKA LASHUN FULLER
Title or Position: PRESIDENT / CEO
Credential:
Phone: 336-471-5973