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General NPI Number Information
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NPI Number | 1205011012
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Entity Type | Organization
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Legal Business Name | LYDIA'S HOME LLC
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 2704 GRIMSLEY ST
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City | GREENSBORO
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State | NC
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Zip | 27403-3138
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Country | US
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Telephone | 336-456-7248
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Fax |
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Provider Business Mailing Address
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Address Line | 2704 GRIMSLEY ST
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City | GREENSBORO
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State | NC
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Zip | 27403-3138
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Country | US
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Telephone | 336-456-7248
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CRYSTAL PRESSLEY
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Credential |
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Telephone | 336-855-6937
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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 |
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License Number State |
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