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General NPI Number Information
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NPI Number | 1699939975
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Entity Type | Organization
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Legal Business Name | MAG HOUSE II
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 1104 W MEADOWVIEW RD
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City | GREENSBORO
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State | NC
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Zip | 27406-4142
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Country | US
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Telephone | 336-558-8628
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 W MEADOWVIEW RD
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City | GREENSBORO
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State | NC
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Zip | 27406-4142
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Country | US
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Telephone | 336-558-8628
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MRS. PHYLLIS BAKER
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Credential | BA
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Telephone | 336-558-8628
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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 | 070293
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License Number State | NC
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