Healthcare Provider Details

I. General information

NPI: 1437167798
Provider Name (Legal Business Name): ALLEGHANY COUNTY GROUP HOMES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 ESTEP STREET
SPARTA NC
28675
US

IV. Provider business mailing address

53 ESTEP STREET
SPARTA NC
28675
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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL003007
License Number StateNC

VIII. Authorized Official

Name: MS. DARLENE DOUGLAS
Title or Position: EXECUTIVE DIRECTOR
Credential: MS
Phone: 336-372-5671