Healthcare Provider Details

I. General information

NPI: 1770590317
Provider Name (Legal Business Name): ALLEGHANY COUNTY GROUP HOMES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 HEALTH SERVICES ROAD
SPARTA NC
28675
US

IV. Provider business mailing address

PO BOX 488
SPARTA NC
28675-0488
US

V. Phone/Fax

Practice location:
  • Phone: 336-372-5671
  • Fax: 336-372-5672
Mailing address:
  • Phone: 336-372-5671
  • Fax: 336-372-5672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberMHL003002
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA J MILLER
Title or Position: EXECUTIVE DIRECTOR
Credential: QP
Phone: 336-372-5671