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General NPI Number Information
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NPI Number | 1598894842
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Entity Type | Organization
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Legal Business Name | BLACK & ASSOCIATES GLOBAL INC
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Dates
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Enumeration Date | 03/04/2007
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | 618 BROAD AVE
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City | GREENSBORO
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State | NC
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Zip | 27406-1705
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Country | US
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Telephone | 336-230-0767
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Fax | 336-454-0191
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Provider Business Mailing Address
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Address Line | 102 BURROWS RD
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City | JAMESTOWN
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State | NC
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Zip | 27282-8400
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Country | US
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Telephone | 336-987-0572
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Fax | 336-454-0191
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. ELLEN ROGERS BLACK
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Credential | OWNER
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Telephone | 336-987-0572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | MHL -041-669
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License Number State | NC
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