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General NPI Number Information
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NPI Number | 1578992962
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Entity Type | Organization
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Legal Business Name | CLEGAIL PROFESSIONAL SERVICES LLC
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 11/05/2013
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Provider Practice Location Address
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Address Line | 711 ASKEW ST
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City | BURLINGTON
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State | NC
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Zip | 27215-2201
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Country | US
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Telephone | 336-825-7223
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Fax |
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Provider Business Mailing Address
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Address Line | 5635 HORNADAY RD UNIT D
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City | GREENSBORO
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State | NC
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Zip | 27409-2941
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. CLEMENT SOWA
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Credential |
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Telephone | 336-825-7223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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