Basic Information
| Provider Information | |||||||||
| NPI: | 1124158746 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EDWARDS GROUP HOME | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 295 | ||||||||
| Address2: | |||||||||
| City: | SNOW HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285800295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527474000 | ||||||||
| FaxNumber: | 2527472602 | ||||||||
| Practice Location | |||||||||
| Address1: | 306 W GREENE ST | ||||||||
| Address2: | |||||||||
| City: | SNOW HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285801436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527474000 | ||||||||
| FaxNumber: | 2527472602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 01/10/2008 | ||||||||
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| AuthorizedOfficialLastName: | MCCOLLUM | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2527474000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | MHL040015 | NC | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
ID Information
| ID | Type | State | Issuer | Description | 7804026 | 01 | NC | PROVIDER NUMBER | OTHER |