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General NPI Number Information
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NPI Number | 1659419281
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Entity Type | Organization
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Legal Business Name | MY SAVIOR FAMILY CARE HOME INC
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Dates
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Enumeration Date | 02/04/2007
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 100 ADAMS BLVD
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City | GREENVILLE
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State | NC
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Zip | 27858-4815
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Country | US
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Telephone | 252-347-4451
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Fax | 252-321-4829
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Provider Business Mailing Address
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Address Line | 755 JOHNS HOPKINS DR
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City | GREENVILLE
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State | NC
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Zip | 27834-7221
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Country | US
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Telephone | 252-347-4451
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Fax | 252-321-4829
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Authorized Official
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Title or Position | CEO
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Name | MRS. NANCY B. BOONE
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Credential |
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Telephone | 252-347-4451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL074153
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License Number State | NC
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