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General NPI Number Information
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NPI Number | 1902144314
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Entity Type | Organization
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Legal Business Name | ROUSE'S GROUP HOME INC
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Dates
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Enumeration Date | 01/18/2013
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Last Update Date | 02/20/2013
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Provider Practice Location Address
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Address Line | 5820 NC 135
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City | STONEVILLE
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State | NC
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Zip | 27048-8478
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Country | US
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Telephone | 336-427-3373
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Fax | 336-427-2929
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Provider Business Mailing Address
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Address Line | PO BOX 16
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City | STONEVILLE
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State | NC
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Zip | 27048-0016
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Country | US
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Telephone | 336-427-3373
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Fax | 336-427-2929
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. DEBRA RENE ROUSE
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Credential |
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Telephone | 336-427-0609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | MHL-079-047
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License Number State | NC
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