Healthcare Provider Details

I. General information

NPI: 1386037505
Provider Name (Legal Business Name): CAPE FEAR GROUP HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 OLD EASTWOOD RD UNIT D2-9
WILMINGTON NC
28403-0500
US

IV. Provider business mailing address

PO BOX 4203
WILMINGTON NC
28406-1203
US

V. Phone/Fax

Practice location:
  • Phone: 910-251-5555
  • Fax: 910-251-0590
Mailing address:
  • Phone: 910-251-2555
  • Fax: 910-251-0590

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 Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ED MARTIN WALSH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 910-251-2555