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General NPI Number Information
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NPI Number | 1679939896
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Entity Type | Organization
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Legal Business Name | AMAT GROUP HOMES
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Dates
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Enumeration Date | 01/04/2016
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 906 E PROSPECT AVE
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City | RAEFORD
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State | NC
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Zip | 28376-2328
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Country | US
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Telephone | 910-595-2910
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Fax |
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Provider Business Mailing Address
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Address Line | 5515 PLAIN VIEW HWY
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City | DUNN
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State | NC
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Zip | 28334-6843
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Country | US
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Telephone | 910-922-9583
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | IBILOLA ARIDEGBE
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Credential |
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Telephone | 910-922-9583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | MHL-047-160
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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