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General NPI Number Information
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NPI Number | 1568815264
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Entity Type | Organization
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Legal Business Name | TRANSNET HOME GROUP -MLK Facility
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Dates
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Enumeration Date | 07/18/2016
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Last Update Date | 07/18/2016
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Provider Practice Location Address
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Address Line | 1607 Martin Luther King Jr. Dr.
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City | GREENSBORO
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State | NC
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Zip | 27406
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Country | US
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Telephone | 336-763-9210
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Fax | 888-821-5068
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Provider Business Mailing Address
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Address Line | PO BOX 36266
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City | GREENSBORO
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State | NC
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Zip | 27416-6266
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Country | US
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Telephone | 336-965-7186
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Fax | 888-821-5068
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Authorized Official
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Title or Position | PRESIDENT
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Name | TRENT CURTIS THOMAS
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Credential |
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Telephone | 336-965-7186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | 320800000X
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License Number | MHL-041-1145
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License Number State | NC
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