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General NPI Number Information
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NPI Number | 1043627623
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Entity Type | Organization
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Legal Business Name | STREETS TO HOMES
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 07/16/2014
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Provider Practice Location Address
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Address Line | 202 E ARLINGTON BLVD STE D
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City | GREENVILLE
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State | NC
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Zip | 27858-5021
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Country | US
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Telephone | 252-565-3747
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Fax | 252-565-0301
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Provider Business Mailing Address
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Address Line | 202 E ARLINGTON BLVD STE D
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City | GREENVILLE
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State | NC
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Zip | 27858-5021
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Country | US
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Telephone | 252-565-3747
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Fax | 252-360-4142
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Authorized Official
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Title or Position | CEO
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Name | AMANDA WILLETT
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Credential |
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Telephone | 252-565-3747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | BL006364-06-2014
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License Number State | SC
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