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General NPI Number Information
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NPI Number | 1083033716
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Entity Type | Organization
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Legal Business Name | UNION AVENUE GROUP HOME II
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 04/10/2014
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Provider Practice Location Address
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Address Line | 605 WHITSETT AVE
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City | GIBSONVILLE
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State | NC
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Zip | 27249-2042
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Country | US
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Telephone | 336-214-3028
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Fax |
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Provider Business Mailing Address
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Address Line | 605 WHITSETT AVE
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City | GIBSONVILLE
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State | NC
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Zip | 27249-2042
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Country | US
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Telephone | 336-214-3028
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY N WOODS
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Credential |
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Telephone | 336-214-3028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | MHL-041-1080
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License Number State | NC
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