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General NPI Number Information
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NPI Number | 1861690877
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Entity Type | Organization
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Legal Business Name | ST. GALE'S MANOR
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 1411 LEES CHAPEL RD
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City | GREENSBORO
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State | NC
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Zip | 27405-1615
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Country | US
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Telephone | 336-621-5336
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14982
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City | GREENSBORO
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State | NC
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Zip | 27415-4982
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Country | US
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Telephone | 336-691-5388
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Fax | 336-691-5389
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES JR. LAWSON
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Credential |
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Telephone | 336-621-5336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | HAL-041-023
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License Number State | NC
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