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General NPI Number Information
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NPI Number | 1740517697
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Entity Type | Organization
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Legal Business Name | PELHAM GARDENS
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Dates
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Enumeration Date | 11/13/2009
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 306 OLD HWY 29
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City | PELHAM
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State | NC
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Zip | 27311
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Country | US
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Telephone | 336-210-1446
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 38551
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City | GREENSBORO
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State | NC
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Zip | 27438
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MR. GREGORY VINCENT
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Credential |
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Telephone | 336-210-1446
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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 |
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