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General NPI Number Information
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NPI Number | 1235323817
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Entity Type | Organization
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Legal Business Name | WORTHAM'S GROUP HOME
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 475 RIFLE RANGE ROAD
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City | WARRENTON
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State | NC
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Zip | 27589
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Country | US
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Telephone | 252-257-0755
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Fax | 252-257-9147
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Provider Business Mailing Address
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Address Line | 475 RIFLE RANGE ROAD
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City | WARRENTON
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State | NC
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Zip | 27589
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Country | US
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Telephone | 252-257-0755
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Fax | 252-257-9147
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ALMEDA WORTHAM
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Credential |
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Telephone | 252-257-0755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | MHL-093-049
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License Number State | NC
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