| Providence Group Home | |
|
941 E Salisbury St Asheboro NC 27203-5049 | |
| (336) 625-1500 | |
| (336) 625-2767 |
| Full Name | Providence Group Home |
|---|---|
| Speciality | Custodial Care Facility - Adult Care Home |
| Location | 941 E Salisbury St, Asheboro, North Carolina |
| Authorized Official Name and Position | Kenneth Alan Burrow (VICE PRESIDENT) |
| Authorized Official Contact | 3364952700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Group Home Po Box 814 Randleman NC 27317-0814 Ph: (336) 495-2700 | Providence Group Home 941 E Salisbury St Asheboro NC 27203-5049 Ph: (336) 625-1500 |
| NPI Number | 1164468104 |
|---|---|
| Provider Enumeration Date | 06/20/2006 |
| Last Update Date | 06/13/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164468104 | NPI | - | NPPES |
| 3408682 | Medicaid | NC | |
| 7801237 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 311ZA0620X | Custodial Care Facility - Adult Care Home | MHL076047 (North Carolina) | Primary |
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