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General NPI Number Information
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NPI Number | 1821312521
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Entity Type | Organization
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Legal Business Name | 210 UNION AVENUE GROUP HOME
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 210 UNION AVE
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City | BURLINGTON
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State | NC
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Zip | 27217-2442
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Country | US
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Telephone | 336-226-6798
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Fax | 336-228-9376
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Provider Business Mailing Address
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Address Line | 210 UNION AVE
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City | BURLINGTON
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State | NC
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Zip | 27217-2442
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Country | US
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Telephone | 336-226-6798
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Fax | 336-228-9376
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Authorized Official
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Title or Position | OWNER
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Name | MARY GRAVES WOODS
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Credential |
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Telephone | 336-226-6798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | MHL 001-174
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License Number State | NC
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