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General NPI Number Information
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NPI Number | 1487774501
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Entity Type | Organization
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Legal Business Name | CENTER OF PROGRESSIVE STRIDES, INC
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 2212 GLENSIDE DR.
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City | GREENSBORO
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State | NC
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Zip | 27455-7455
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Country | US
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Telephone | 336-375-3099
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Fax |
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Provider Business Mailing Address
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Address Line | 29 HOLLY SPRINGS LN
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City | GREENSBORO
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State | NC
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Zip | 27455-1526
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Country | US
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Telephone | 336-327-8682
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JAMES EDWARD HINSON JR.
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Credential |
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Telephone | 336-327-8682
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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 | MHL-041-807
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License Number State | NC
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