=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841336062
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROUSE'S GROUP HOME, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2007
-----------------------------------------------------
Last Update Date | 09/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5949 NC 135
-----------------------------------------------------
City | STONEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27048-8479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-427-8562
-----------------------------------------------------
Fax | 336-427-2978
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5949 NC 135
-----------------------------------------------------
City | STONEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27048-8479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-427-2532
-----------------------------------------------------
Fax | 336-427-2978
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DEBRA RENEE ROUSE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-427-0609
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 315P00000X
-----------------------------------------------------
Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
-----------------------------------------------------
License Number | MHL-079-047
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 315P00000X
-----------------------------------------------------
Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
-----------------------------------------------------
License Number | MHL-079-004
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------