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General NPI Number Information
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NPI Number | 1720116072
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Entity Type | Organization
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Legal Business Name | INFINITY OPTIONS RESIDENTIAL FACILITY
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 122 FLETCHER PL
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City | GREENVILLE
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State | NC
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Zip | 27858-4723
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Country | US
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Telephone | 252-329-9121
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Fax |
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Provider Business Mailing Address
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Address Line | 201 HICKORY BRANCHES CLOSE
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City | WINTERVILLE
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State | NC
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Zip | 28590-9210
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Country | US
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Telephone | 252-752-4814
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. SHARON DENISE EVANS
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Credential | M.A.ED
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Telephone | 252-258-3940
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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 | MHL-074-147
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License Number State | NC
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