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General NPI Number Information
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NPI Number | 1457554594
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Entity Type | Organization
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Legal Business Name | GRANVILLE COUNTY GROUP HOMES, INC.
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5509 DORSEY RD
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City | OXFORD
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State | NC
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Zip | 27565-8309
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Country | US
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Telephone | 919-528-4610
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Fax |
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Provider Business Mailing Address
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Address Line | 5509 DORSEY RD
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City | OXFORD
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State | NC
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Zip | 27565-8309
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Country | US
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Telephone | 919-528-4610
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. SKIP SKINNER
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Credential |
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Telephone | 252-438-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | MHL039002
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License Number State | NC
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