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General NPI Number Information
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NPI Number | 1730211392
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Entity Type | Organization
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Legal Business Name | CORFU GROUP HOME
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 7001 CORFU PL
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City | WENDELL
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State | NC
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Zip | 27591-6720
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Country | US
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Telephone | 919-366-9181
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Fax | 919-366-1090
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Provider Business Mailing Address
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Address Line | 7001 CORFU PL
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City | WENDELL
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State | NC
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Zip | 27591-6720
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Country | US
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Telephone | 919-366-9181
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Fax | 919-366-1090
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MICHELLE KIRBY
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Credential |
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Telephone | 919-669-2721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | MHL092552
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License Number State | NC
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