| NPI | 1164468104 |
|---|---|
| Other Name | PROVIDENCE GROUP HOME |
| Entity Type | Organization |
| Authorized Contact | KENNETH ALAN BURROW Vice President 336-495-2700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC MHL076047) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2013-06-13 |