Healthcare Provider Details

I. General information

NPI: 1255097127
Provider Name (Legal Business Name): CAPE FEAR GROUP HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 HEALY DR STE 204
WINSTON SALEM NC
27103-1568
US

IV. Provider business mailing address

PO BOX 4203
WILMINGTON NC
28406-1203
US

V. Phone/Fax

Practice location:
  • Phone: 336-293-4018
  • Fax: 910-251-0590
Mailing address:
  • Phone: 910-251-2555
  • Fax: 910-251-0590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KEYANA LATRISE MAPSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 910-251-2555