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General NPI Number Information
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NPI Number | 1285033761
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Entity Type | Organization
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Legal Business Name | UNIVERSAL GROUP HOME LLC
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Dates
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Enumeration Date | 08/20/2014
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Last Update Date | 08/20/2014
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Provider Practice Location Address
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Address Line | 609 E MAIN ST
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City | MOUNT OLIVE
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State | NC
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Zip | 28365-2248
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Country | US
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Telephone | 919-344-8846
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Fax |
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Provider Business Mailing Address
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Address Line | 411 FOREST DR
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City | GOLDSBORO
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State | NC
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Zip | 27534-3323
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Country | US
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Telephone | 919-344-8846
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SANDRA FAYE SPRUILL
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Credential |
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Telephone | 919-344-8846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | MHL-031-075
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | MHL-096-254
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | MHL-096-255
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License Number State | NC
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