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General NPI Number Information
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NPI Number | 1538405626
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Entity Type | Organization
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Legal Business Name | ABUNDANCE OF FAITH X 5
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Dates
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Enumeration Date | 12/18/2012
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Last Update Date | 12/18/2012
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Provider Practice Location Address
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Address Line | 301 WENTWORTH ST
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City | REIDSVILLE
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State | NC
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Zip | 27320-2231
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Country | US
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Telephone | 336-432-7141
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Fax |
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Provider Business Mailing Address
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Address Line | 301 WENTWORTH ST
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City | REIDSVILLE
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State | NC
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Zip | 27320-2231
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Country | US
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Telephone | 336-432-7141
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | LATOYA LENORE THURSTON-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 | FCL-079-056
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License Number State | NC
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