| Kyseem's Unity Group Home, Llc | |
|
408 East Tarboro Street Pinetops NC 27864-2786 | |
| (252) 902-7078 | |
| (252) 756-8586 |
| Full Name | Kyseem's Unity Group Home, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 408 East Tarboro Street, Pinetops, North Carolina |
| Authorized Official Name and Position | Dearl Ray Powell (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2529027078 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kyseem's Unity Group Home, Llc Po Box 129 Pinetops NC 27864-0129 Ph: (252) 902-6277 | Kyseem's Unity Group Home, Llc 408 East Tarboro Street Pinetops NC 27864-2786 Ph: (252) 902-7078 |
| NPI Number | 1538488192 |
|---|---|
| Provider Enumeration Date | 05/21/2010 |
| Last Update Date | 01/20/2022 |
| Certification Date | 01/15/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538488192 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MHL033076 (North Carolina) | Primary |
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