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General NPI Number Information
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NPI Number | 1275676074
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Entity Type | Organization
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Legal Business Name | L&M GROUP HOMES INC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 936 WATERLESS STREET
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-1606
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Country | US
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Telephone | 910-484-1704
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Fax | 910-484-1704
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Provider Business Mailing Address
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Address Line | 3327 LAKE BEND DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28311-7661
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Country | US
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Telephone | 910-425-7391
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Fax | 910-484-1704
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Authorized Official
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Title or Position | CHEIF EXECUTIVE OFFICER
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Name | MR. SHELTON LEON MELVIN
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Credential | BS, AP
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Telephone | 910-425-7391
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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 | MHL-026-748
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License Number State | NC
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