Healthcare Provider Details

I. General information

NPI: 1336285337
Provider Name (Legal Business Name): PCGH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N MAIN ST.
ROXBORO NC
27573-0721
US

IV. Provider business mailing address

P O BOX 721
ROXBORO NC
27573-0721
US

V. Phone/Fax

Practice location:
  • Phone: 336-599-9421
  • Fax: 336-599-7220
Mailing address:
  • Phone: 336-599-9421
  • Fax: 336-599-7220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number StateNC

VIII. Authorized Official

Name: MELISSA S DAY
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 336-599-9421