MEDICARE: THE ECCLESIASTES HOUSE, LLC

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number	:	1649457938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ECCLESIASTES HOUSE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1664
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27261-1664
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 COPPERSTONE DR
Second Line	:	1 - C
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8099
Country	:	US
Telephone Number	:	336-882-1894
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MARIE MCGEE
Credential	:
Telephone Number	:	336-882-1894

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	01/29/2008

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