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General NPI Number Information
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NPI Number | 1568554293
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Entity Type | Organization
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Legal Business Name | FRIENDWAY GROUP HOME
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 202 FRIENDWAY RD
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City | GREENSBORO
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State | NC
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Zip | 27409-2116
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Country | US
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Telephone | 336-852-2636
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Fax |
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Provider Business Mailing Address
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Address Line | 3210 FAIRHILL DR
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City | RALEIGH
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State | NC
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Zip | 27612-3220
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Country | US
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Telephone | 919-256-0824
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDY ANDERSON
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Credential |
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Telephone | 910-642-5697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | MHL041070
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License Number State | NC
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