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General NPI Number Information
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NPI Number | 1598068900
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Entity Type | Organization
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Legal Business Name | BLACKWELL'S COMMUNITY LIVING LLC
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 509 FERNWAY DR
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City | BURLINGTON
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State | NC
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Zip | 27217-8850
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Country | US
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Telephone | 336-270-4463
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Fax | 336-897-7564
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Provider Business Mailing Address
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Address Line | 509 FERNWAY DR
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City | BURLINGTON
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State | NC
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Zip | 27217-8850
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Country | US
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Telephone | 336-270-4463
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Fax | 336-897-7564
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. ROBIN NEWBY BLACKWELL
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Credential |
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Telephone | 336-317-1926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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