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General NPI Number Information
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NPI Number | 1568526499
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Entity Type | Organization
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Legal Business Name | PIEDMONT PIONEER HOUSE, INC.
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 910 ROBERTS DR
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City | GASTONIA
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State | NC
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Zip | 28054-5804
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Country | US
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Telephone | 704-884-2700
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Fax | 704-854-4234
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Provider Business Mailing Address
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Address Line | 910 ROBERTS DR
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City | GASTONIA
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State | NC
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Zip | 28054-5804
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Country | US
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Telephone | 704-884-2700
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Fax | 704-854-4234
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. VONDA KAYE BURTON
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Credential | QMHP, QDDP
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Telephone | 704-884-2701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | MHL-036-004
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License Number State | NC
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