Healthcare Provider Details

I. General information

NPI: 1336200633
Provider Name (Legal Business Name): THE ASBURY HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11337 JOE BROWN HWY S
TABOR CITY NC
28463-8597
US

IV. Provider business mailing address

11337 JOE BROWN HWY S
TABOR CITY NC
28463-8597
US

V. Phone/Fax

Practice location:
  • Phone: 910-653-5050
  • Fax: 910-653-6123
Mailing address:
  • Phone: 910-653-5050
  • Fax: 910-653-6123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL-024-026
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL-024-026
License Number StateNC

VIII. Authorized Official

Name: MRS. LISA HAYES
Title or Position: PROGRAM COORDINATOR
Credential:
Phone: 910-653-5050