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General NPI Number Information
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NPI Number | 1235328881
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Entity Type | Organization
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Legal Business Name | MY SAVIOR FAMILY CARE HOME, INC.
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 3200 BRIARCLIFF DR
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City | GREENVILLE
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State | NC
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Zip | 27834-4948
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Country | US
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Telephone | 252-347-4451
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Fax | 252-321-4829
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Provider Business Mailing Address
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Address Line | PO BOX 20702
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City | GREENVILLE
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State | NC
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Zip | 27858-0702
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Country | US
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Telephone | 252-347-4451
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Fax | 252-321-4829
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Authorized Official
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Title or Position | OWNER
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Name | MRS. NANCY BARNES BOONE
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Credential |
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Telephone | 252-347-4451
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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 | MHL074154
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License Number State | NC
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