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General NPI Number Information
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NPI Number | 1871735233
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Entity Type | Organization
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Legal Business Name | DFM INCORPORTATED ADOLESCENT HOME
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 3999 FAYETTEVILLE RD
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City | RAEFORD
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State | NC
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Zip | 28376-8059
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Country | US
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Telephone | 910-273-5473
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Fax | 919-498-0874
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Provider Business Mailing Address
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Address Line | 7735 S SHIELD DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-6352
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Country | US
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Telephone | 910-273-5473
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Fax | 919-498-0874
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Authorized Official
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Title or Position | CEO
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Name | MS. TIFFANY DELORSE MONROE
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Credential | BS
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Telephone | 910-273-5473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | MHL-047-112
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License Number State | NC
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