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General NPI Number Information
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NPI Number | 1518001544
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Entity Type | Organization
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Legal Business Name | VINEYARD HOMES, INC.
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2704 WARRICK CIR
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City | GOLDSBORO
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State | NC
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Zip | 27534-7658
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Country | US
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Telephone | 919-778-3412
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Fax | 919-778-3412
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Provider Business Mailing Address
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Address Line | 2704 WARRICK CIR
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City | GOLDSBORO
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State | NC
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Zip | 27534-7658
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Country | US
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Telephone | 919-778-3412
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Fax | 919-778-3412
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Authorized Official
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Title or Position | PRESIDENT - OWNER
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Name | ROBERT EARL GRANT JR.
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Credential | B.S.
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Telephone | 919-751-0503
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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-096-133
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License Number State | NC
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