MEDICARE: ROCKERFELLER CREWS EDUCATIONAL FOUNDATION

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	6591798	NC

General Provider Information

NPI Number	:	1962891135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKERFELLER CREWS EDUCATIONAL FOUNDATION

Provider Business Mailing Address
First Line	:	2 GREY OAKS CIR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27408-5700
Country	:	US
Telephone Number	:	336-255-8017
Fax Number	:

Provider Business Practice Location Address
First Line	:	824 WAUGH ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-6074
Country	:	US
Telephone Number	:	336-255-8017
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LC CREWS
Credential	:
Telephone Number	:	336-255-8017

Provider Enumeration Date	:	01/12/2015
Last Update Date	:	01/12/2015

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