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General NPI Number Information
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NPI Number | 1366630162
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Entity Type | Organization
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Legal Business Name | CAMERON COURT, LLC
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 1002 JULIAN ST
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City | GREENSBORO
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State | NC
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Zip | 27406-2153
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Country | US
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Telephone | 336-273-0489
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Fax | 336-271-2906
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Provider Business Mailing Address
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Address Line | 4642 W MARKET ST SUITE 203
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City | GREENSBORO
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State | NC
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Zip | 27407-1285
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Country | US
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Telephone | 336-273-0489
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Fax | 336-271-2906
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | MS. TEBONY CAMISHA VINCENT
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Credential |
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Telephone | 336-273-0489
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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 | MHL041830
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License Number State | NC
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