=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033839568
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOYA'S PROJECT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2022
-----------------------------------------------------
Last Update Date | 09/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1995 BLUE ROCK CT
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27405-1834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-340-6399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1995 BLUE ROCK CT
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27405-1834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-340-6399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KENYATTA NECOLE DAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-340-6399
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------