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General NPI Number Information
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NPI Number | 1053588277
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Entity Type | Organization
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Legal Business Name | S&K GRACIOUS LIVING LLC
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 595 BLAND SCHOOL RD
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City | HARRELLS
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State | NC
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Zip | 28444-7601
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Country | US
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Telephone | 910-532-4775
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Fax |
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Provider Business Mailing Address
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Address Line | 376 BUCKHORN RD
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City | WILLARD
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State | NC
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Zip | 28478-9666
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Country | US
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Telephone | 910-532-4775
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MRS. JANICE S BEATTY
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Credential |
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Telephone | 910-532-4775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL082-074
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License Number State | NC
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