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General NPI Number Information
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NPI Number | 1932830932
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Entity Type | Organization
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Legal Business Name | KEY WEST II
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Dates
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Enumeration Date | 06/21/2022
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Last Update Date | 06/21/2022
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Provider Practice Location Address
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Address Line | 1722 ATHENS AVE
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City | DURHAM
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State | NC
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Zip | 27707-4312
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Country | US
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Telephone | 919-564-7543
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Fax |
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Provider Business Mailing Address
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Address Line | 1012 GREGORY ST
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City | GREENSBORO
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State | NC
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Zip | 27403-3029
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Country | US
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Telephone | 336-274-1269
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Fax | 336-272-2387
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIE LEE GIBSON
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Credential |
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Telephone | 336-274-1269
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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 |
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License Number State |
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