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General NPI Number Information
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NPI Number | 1275637852
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Entity Type | Organization
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Legal Business Name | MYROVER-REESE FELLOWSHIP HOMES INC.
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 560 WILKES RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-3038
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Country | US
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Telephone | 910-486-8718
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Fax | 910-486-5976
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Provider Business Mailing Address
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Address Line | PO BOX 64933
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-0933
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Country | US
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Telephone | 910-486-8718
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Fax | 910-486-5976
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. WILLIAM F FRYE SR.
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Credential |
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Telephone | 910-486-8718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | MHL026005
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License Number State | NC
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