MEDICARE: NICHOLAS SLAYTON

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

General Provider Information

NPI Number	:	1659207223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS SLAYTON

Provider Business Mailing Address
First Line	:	4811 BLACK FOREST DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-9826
Country	:	US
Telephone Number	:	434-709-8317
Fax Number	:	434-709-8317

Provider Business Practice Location Address
First Line	:	4811 BLACK FOREST DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-9826
Country	:	US
Telephone Number	:	434-709-8317
Fax Number	:	434-709-8317

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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Directions to “ NICHOLAS SLAYTON ” Practice Location

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