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General NPI Number Information
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NPI Number | 1295143881
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Entity Type | Organization
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Legal Business Name | NACOLBY'S HOUSE, INCORPORATED
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Dates
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Enumeration Date | 07/26/2014
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Last Update Date | 07/26/2014
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Provider Practice Location Address
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Address Line | 104 PRISTINE DR
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City | LOCUST GROVE
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State | GA
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Zip | 30248-3746
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Country | US
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Telephone | 757-717-1960
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2513
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City | CHESAPEAKE
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State | VA
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Zip | 23327-2513
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | DEBORAH JENNINGS
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Credential |
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Telephone | 757-717-1960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number |
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License Number State | GA
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