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General NPI Number Information
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NPI Number | 1255581351
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Entity Type | Organization
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Legal Business Name | GHHM NORTHRIDGE GROUP HOME
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 105 RITTERS LAKE RD
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City | GREENSBORO
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State | NC
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Zip | 27406-9249
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Country | US
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Telephone | 336-676-9312
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16064
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City | GREENSBORO
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State | NC
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Zip | 27416-0064
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Country | US
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Telephone | 336-676-9312
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. CHARY CURTIS
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Credential |
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Telephone | 336-676-9312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | MHL041-528
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License Number State | NC
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