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General NPI Number Information
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NPI Number | 1003353475
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Entity Type | Organization
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Legal Business Name | EASON COURT GROUP HOME LLC #2
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 124 GREGORY MNR
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City | YOUNGSVILLE
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State | NC
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Zip | 27596-9614
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Country | US
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Telephone | 919-556-5355
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Fax | 866-285-8824
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Provider Business Mailing Address
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Address Line | PO BOX 759
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City | YOUNGSVILLE
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State | NC
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Zip | 27596-0759
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Country | US
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Telephone | 919-556-5355
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Fax | 866-285-8824
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Authorized Official
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Title or Position | ASSISTANT DIRECTOR
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Name | SONJA DENISE WILLIAMS
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Credential |
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Telephone | 571-288-4144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | MHL 035 029
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | MHL 035 050
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License Number State | NC
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