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General NPI Number Information
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NPI Number | 1417492745
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Entity Type | Organization
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Legal Business Name | BUT GOD LLC
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Dates
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Enumeration Date | 12/22/2016
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 1408 W FIELDCREST RD
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City | EDEN
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State | NC
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Zip | 27288-3932
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Country | US
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Telephone | 336-635-9347
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Fax |
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Provider Business Mailing Address
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Address Line | 1408 W FIELDCREST RD
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City | EDEN
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State | NC
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Zip | 27288-3932
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Country | US
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Telephone | 336-635-9347
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | LATOYA GRIGGS
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Credential |
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Telephone | 336-432-7141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | FCL079056
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | FCL079095
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License Number State | NC
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