| Sanctuary House | |
|
411 W Fisher Ave Greensboro NC 27401-2039 | |
| (336) 275-7896 | |
| Not Available |
| Full Name | Sanctuary House |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 411 W Fisher Ave, Greensboro, North Carolina |
| Authorized Official Name and Position | Elizabeth Theisen (OPERATIONS) |
| Authorized Official Contact | 3362757896 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sanctuary House 518 N Elm St Greensboro NC 27401-2018 Ph: () - | Sanctuary House 411 W Fisher Ave Greensboro NC 27401-2039 Ph: (336) 275-7896 |
| NPI Number | 1720219330 |
|---|---|
| Provider Enumeration Date | 07/30/2009 |
| Last Update Date | 10/04/2021 |
| Certification Date | 10/04/2021 |
| Medicare PECOS PAC ID | 0941326920 |
|---|---|
| Medicare Enrollment ID | O20221229002713 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720219330 | NPI | - | NPPES |
| 6006775 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Brittany Shydae Hargrove |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306271317 PECOS PAC ID: 4385904630 Enrollment ID: I20180205002220 |
| Provider Name | Summer Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225696990 PECOS PAC ID: 2668809690 Enrollment ID: I20230111000385 |
| Provider Name | Andrea Rashika Liles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619456712 PECOS PAC ID: 1456715325 Enrollment ID: I20230911002268 |
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