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General NPI Number Information
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NPI Number | 1639043789
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Entity Type | Organization
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Legal Business Name | TULIPTREE GROUP HOME LLC
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Dates
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Enumeration Date | 10/01/2025
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 4702 TULIPTREE DR
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City | GREENSBORO
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State | NC
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Zip | 27455-3402
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Country | US
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Telephone | 336-285-5945
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Fax |
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Provider Business Mailing Address
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Address Line | 4702 TULIPTREE DR
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City | GREENSBORO
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State | NC
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Zip | 27455-3402
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Country | US
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Telephone | 336-285-5945
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | MS. LARAE VERNITA POTTER
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Credential | AFL PROVIDER
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Telephone | 336-221-6357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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