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General NPI Number Information
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NPI Number | 1417176991
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Entity Type | Organization
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Legal Business Name | LILY OF THE VALLEY, INC.
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4107 MAYNARD CIR
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City | FRANKLINTON
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State | NC
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Zip | 27525-7576
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Country | US
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Telephone | 919-528-7285
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Fax | 919-528-7285
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Provider Business Mailing Address
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Address Line | 4107 MAYNARD CIR
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City | FRANKLINTON
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State | NC
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Zip | 27525-7576
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Country | US
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Telephone | 919-528-7285
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Fax | 919-528-7285
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CANDICE MORGAN SANFORD
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Credential |
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Telephone | 919-554-2221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | MHL-092660
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License Number State | NC
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