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General NPI Number Information
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NPI Number | 1972882868
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Entity Type | Organization
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Legal Business Name | GRIFFIN SUPERVISED LIVING
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Dates
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Enumeration Date | 08/09/2011
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Last Update Date | 08/03/2015
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Provider Practice Location Address
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Address Line | 2 PARTNERSHIP CT
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City | GREENSBORO
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State | NC
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Zip | 27405-5200
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Country | US
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Telephone | 336-412-5947
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Fax | 336-375-7179
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Provider Business Mailing Address
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Address Line | 2 PARTNERSHIP CT
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City | GREENSBORO
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State | NC
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Zip | 27405-5200
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Country | US
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Telephone | 336-412-5947
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Fax | 336-375-7179
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Authorized Official
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Title or Position | CO-OWNER
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Name | MRS. SHELIA WALL GRIFFIN
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Credential |
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Telephone | 336-412-5947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | MHL-041-856
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License Number State | NC
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