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General NPI Number Information
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NPI Number | 1821824681
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Entity Type | Organization
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Legal Business Name | MARY MANOR II
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Dates
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Enumeration Date | 09/10/2024
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 501 BUNN ST
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City | ZEBULON
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State | NC
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Zip | 27597-9177
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Country | US
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Telephone | 919-269-3060
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Fax |
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Provider Business Mailing Address
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Address Line | 5641 QUAIL COVEY LN
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City | WENDELL
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State | NC
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Zip | 27591-7901
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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
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Name | MARY L. MCCULLERS
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Credential |
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Telephone | 919-796-5780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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