Organization Name: | BLACKWELL HOUSE INC. |
NPI Number: | 1083919518 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LATONYA FAYE TINNIN (QUALIFIED PROFESSIONAL/ DIRECTOR) |
Mailing Address: | 2805 N Ohenry Blvd Greensboro |
State: | NC US |
Postal Code: | 274054631 |
Phone Number: | 3363753121 |
Fax Number: | |
NPI Enumeration Date: | 01/13/2011 |
NPI Last Update Date: | 01/13/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320800000X |
License Number: | 041-997 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |