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General NPI Number Information
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NPI Number | 1568951515
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Entity Type | Organization
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Legal Business Name | MPKG RESTORING FAMILIES EFFECTIVELY LLC
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Dates
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Enumeration Date | 05/05/2018
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 236 N MEBANE ST STE 107
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City | BURLINGTON
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State | NC
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Zip | 27217-3900
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Country | US
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Telephone | 336-512-6502
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Fax | 336-227-5534
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Provider Business Mailing Address
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Address Line | 1114 SHAW ST
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City | BURLINGTON
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State | NC
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Zip | 27217-1545
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Country | US
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Telephone | 336-285-8577
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | CLARISSA D PAUL
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Credential |
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Telephone | 336-512-6502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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