MEDICARE: A DAY OF DISTINCTION

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	251S00000X	Community/Behavioral Health Agency	MHL-041-1056	NC

General Provider Information

NPI Number	:	1790037976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A DAY OF DISTINCTION

Provider Business Mailing Address
First Line	:	1106 E MARKET ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-3267
Country	:	US
Telephone Number	:	336-317-9226
Fax Number	:

Provider Business Practice Location Address
First Line	:	1106 E MARKET ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-3267
Country	:	US
Telephone Number	:	336-317-9226
Fax Number	:

Authorized Official
Title or Position	:	QP
Name	:	MR. THOMAS RAYMOND WOODSON
Credential	:	B.S.
Telephone Number	:	336-317-9226

Provider Enumeration Date	:	10/11/2012
Last Update Date	:	10/11/2012

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Directions to “A DAY OF DISTINCTION ” Practice Location

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