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General NPI Number Information
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NPI Number | 1689970956
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Entity Type | Organization
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Legal Business Name | DE-BORAH'S HOPE HOUSE
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Dates
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Enumeration Date | 02/04/2011
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Last Update Date | 02/04/2011
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Provider Practice Location Address
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Address Line | 3113 MCCONNELL RD
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City | GREENSBORO
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State | NC
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Zip | 27405-9611
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Country | US
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Telephone | 336-274-1988
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Fax | 336-834-2215
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Provider Business Mailing Address
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Address Line | 4701 FOX TROT RD
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City | GREENSBORO
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State | NC
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Zip | 27406-8235
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Country | US
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Telephone | 336-908-1152
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Fax | 336-834-2215
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARIAN ALSTON WALLACE
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Credential |
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Telephone | 336-908-1152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | MHL-041-1005
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License Number State | NC
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