Healthcare Provider Details

I. General information

NPI: 1679675656
Provider Name (Legal Business Name): ZOE: BEHAVIOR HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 S MARTIN LUTHER KING JR DR BOX N SUITE 224
WINSTON SALEM NC
27107-1361
US

IV. Provider business mailing address

1922 S MARTIN LUTHER KING JR DR BOX N SUITE 224
WINSTON SALEM NC
27107-1361
US

V. Phone/Fax

Practice location:
  • Phone: 336-734-6911
  • Fax: 336-734-6917
Mailing address:
  • Phone: 336-734-6911
  • Fax: 336-734-6917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number9046
License Number StateNC

VIII. Authorized Official

Name: MS. APRIL B WITHERSPOON
Title or Position: CEO, DIRECTOR
Credential: B.A.SOCIOLOGY
Phone: 336-734-6911