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General NPI Number Information
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NPI Number | 1316648074
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Entity Type | Organization
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Legal Business Name | SANDRAS HOUSE GROUP HOMES, LLC
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Dates
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Enumeration Date | 03/10/2023
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Last Update Date | 03/10/2023
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Provider Practice Location Address
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Address Line | 1856 STONY POINT ROAD
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City | SHELBY
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State | NC
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Zip | 28150
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Country | US
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Telephone | 704-802-4145
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 REMOUNT ROAD SUITE E-104
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City | GASTONIA
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State | NC
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Zip | 28054
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Country | US
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Telephone | 704-777-4335
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Fax | 251-980-1509
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR OWNER
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Name | MRS. DIANNE HUITT
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Credential | CADC
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Telephone | 704-802-4145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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