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General NPI Number Information
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NPI Number | 1881866002
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Entity Type | Organization
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Legal Business Name | EBENEZER CHRISTIAN CHILDRENS HOME
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 1006 BYRD RIDGE RD
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City | NORTH WILKESBORO
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State | NC
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Zip | 28659-8044
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Country | US
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Telephone | 336-667-5683
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Fax | 336-667-8634
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Provider Business Mailing Address
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Address Line | P.O. BOX 2777
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City | NORTH WILKESBORO
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State | NC
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Zip | 28659-2777
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Country | US
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Telephone | 336-667-5683
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Fax | 336-667-8634
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. JEAN DAVIS
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Credential |
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Telephone | 336-667-5683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL-097-061
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License Number State | NC
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