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General NPI Number Information
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NPI Number | 1710022785
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Entity Type | Organization
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Legal Business Name | IRENE WORTHAM RESIDENTIAL CENTER, INC.
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 16 AZALEA STREET
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City | ASHEVILLE
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State | NC
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Zip | 28803-2814
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Country | US
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Telephone | 828-274-7518
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Fax | 828-274-1582
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Provider Business Mailing Address
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Address Line | 916 WEST CHAPEL ROAD
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City | ASHEVILLE
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State | NC
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Zip | 28803-2844
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Country | US
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Telephone | 828-274-7518
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Fax | 828-274-1582
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | R. MATTHEW HENRY
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Credential |
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Telephone | 828-274-7518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | MHL-011-036
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License Number State | NC
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