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General NPI Number Information
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NPI Number | 1841513652
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Entity Type | Organization
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Legal Business Name | AT&B RESIDENTIAL ADULT GROUP SERVICES
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Dates
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Enumeration Date | 03/08/2010
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Last Update Date | 03/08/2010
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Provider Practice Location Address
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Address Line | 215 W RUFFIN ST
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City | BURLINGTON
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State | NC
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Zip | 27217-2643
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Country | US
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Telephone | 336-222-8837
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2274
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City | BURLINGTON
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State | NC
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Zip | 27216-2274
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Country | US
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Telephone | 336-222-8837
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | TAMMIE NORMAN
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Credential |
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Telephone | 336-684-5079
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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 | MHL-001-175
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License Number State | NC
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