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General NPI Number Information
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NPI Number | 1508900457
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Entity Type | Organization
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Legal Business Name | SIXTH STREET DDA GROUP HOME
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 313 E 6TH ST
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City | BURLINGTON
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State | NC
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Zip | 27215-5732
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Country | US
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Telephone | 336-222-1812
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Fax |
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Provider Business Mailing Address
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Address Line | 313 E 6TH ST
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City | BURLINGTON
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State | NC
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Zip | 27215-5732
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Country | US
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Telephone | 336-222-1812
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CURTIS EUGENE TORAIN
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Credential |
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Telephone | 336-222-1812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | DDL001024
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License Number State | NC
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