=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558499699
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ISLEYS HANDS ON CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 521 HENLEY COUNTRY RD
-----------------------------------------------------
City | ASHEBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-629-2067
-----------------------------------------------------
Fax | 336-629-1657
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 521 HENLEY COUNTRY RD
-----------------------------------------------------
City | ASHEBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-629-2067
-----------------------------------------------------
Fax | 336-629-1657
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR OWNER
-----------------------------------------------------
Name | MR. BRUCE KENTON ISLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-629-2067
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | MHL076073
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------