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General NPI Number Information
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NPI Number | 1720692833
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Entity Type | Organization
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Legal Business Name | TGH PHASE 2
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 231 S MAIN ST STE B
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City | SALISBURY
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State | NC
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Zip | 28144-4971
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Country | US
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Telephone | 980-330-3037
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Fax | 980-330-3057
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Provider Business Mailing Address
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Address Line | 231 S MAIN ST STE B
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City | SALISBURY
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State | NC
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Zip | 28144-4971
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Country | US
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Telephone | 980-330-3037
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Fax | 980-330-3057
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAJUANA GREENARD HOOKER
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Credential |
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Telephone | 980-643-7842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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