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General NPI Number Information
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NPI Number | 1689807448
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Entity Type | Organization
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Legal Business Name | EMMANUEL MINISTRIES INTERNATIONAL, INC.
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Dates
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Enumeration Date | 08/27/2009
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Last Update Date | 08/27/2009
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Provider Practice Location Address
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Address Line | 1005 BRUSHY FORK DR
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City | GREENSBORO
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State | NC
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Zip | 27406-8061
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Country | US
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Telephone | 336-617-6510
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Fax | 336-617-6510
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Provider Business Mailing Address
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Address Line | PO BOX 1713
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City | JAMESTOWN
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State | NC
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Zip | 27282-1713
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Country | US
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Telephone | 336-617-6510
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Fax | 336-617-6510
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. CAROLYN JEAN FERNANDEZ
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Credential | MS, MT(ASCP)SH
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Telephone | 336-617-6510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | MHL041913
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License Number State | NC
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