Fairley Support Group Home Inc.

NPI 1710170238 - Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities - 320600000X

NPI Details
NPI 1710170238
Enumeration Date 08/20/2007
Last Updated 08/20/2007
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name TONY MELVIN TONY
Position ADMINISTRATOR/CEO
Phone (910) 844-1880
Fax (910) 844-1880
Practice Location
12519 US HWY 501 SOUTH
MAXTON NC, 28364, US
Phone (910) 844-1880
Fax (910) 844-1880
Business Location
PO BOX 182
12519 US HWY 501 SOUTH
MAXTON NC, 28364-0182, US
Phone (910) 844-1880
Fax (910) 844-1880
Toxanomy
Taxonomy Code 320600000X
License State North Carolina
License Number MHL-078-174
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According to our database, Fairley Support Group Home Inc. NPI is 1710170238, taxonomy code is 320600000X and license number is MHL-078-174, license state is located at North Carolina. Fairley Support Group Home Inc. physically located at 12519 Us Hwy 501 South, Maxton NC, 28364. NPI Number 1033115704 has the healthcare provider type.

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1710170238 NPI number is provided on an as is basis without warranty of any kind. 1710170238 is maintained by the National Plan & Provider Enumeration System. The contents of Fairley Support Group Home Inc. are for informational purposes only.