| Konnoak Drive Group Home | |
|
2901 Konnoak Dr Winston Salem NC 27127-3945 | |
| (800) 866-0860 | |
| Not Available |
| Full Name | Konnoak Drive Group Home |
|---|---|
| Speciality | Intermediate Care Facility, Intellectual Disabilities |
| Location | 2901 Konnoak Dr, Winston Salem, North Carolina |
| Authorized Official Name and Position | Angie Mattingly (MGR PROVIDER ENROLLMENT) |
| Authorized Official Contact | 5026307425 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Konnoak Drive Group Home 805 N Whittington Pkwy Louisville KY 40222-7101 Ph: (800) 866-0860 | Konnoak Drive Group Home 2901 Konnoak Dr Winston Salem NC 27127-3945 Ph: (800) 866-0860 |
| NPI Number | 1639313943 |
|---|---|
| Provider Enumeration Date | 04/30/2009 |
| Last Update Date | 02/21/2022 |
| Certification Date | 02/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639313943 | NPI | - | NPPES |
| 342606W | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (North Carolina) | Secondary |
| 315P00000X | Intermediate Care Facility, Intellectual Disabilities | (* (Not Available)) | Primary |
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