MEDICARE: CHATHAM COUNTY GROUP HOMES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	MHL-019-023	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326165085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHATHAM COUNTY GROUP HOMES, INC.

Provider Business Mailing Address
First Line	:	217 E BEAVER ST
Second Line	:	PO BOX 207
City	:	SILER CITY
State	:	NC
Zip	:	27344-3403
Country	:	US
Telephone Number	:	919-742-2510
Fax Number	:	919-742-3984

Provider Business Practice Location Address
First Line	:	323 M L KING JR BLVD
Second Line	:
City	:	SILER CITY
State	:	NC
Zip	:	27344-3112
Country	:	US
Telephone Number	:	919-742-4790
Fax Number	:

Authorized Official
Title or Position	:	FINANCE MANAGER
Name	:	DIANE BURNS
Credential	:
Telephone Number	:	919-742-2510

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	08/22/2020

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