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General NPI Number Information
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NPI Number | 1962690891
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Entity Type | Organization
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Legal Business Name | MELVIN AND JOHNSON COMMUNITY LIVING
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 169 FRONT ST
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City | RED SPRINGS
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State | NC
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Zip | 28377-1713
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Country | US
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Telephone | 910-843-3659
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Fax | 910-843-3659
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Provider Business Mailing Address
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Address Line | PO BOX 851
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City | RED SPRINGS
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State | NC
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Zip | 28377-0851
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Country | US
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Telephone | 910-843-3659
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Fax | 910-843-3659
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Authorized Official
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Title or Position | OWNER
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Name | MS. APRIL CHECRECE JOHNSON
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Credential |
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Telephone | 910-818-8797
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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-078-195
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License Number State | NC
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