Basic Information
| Provider Information | |||||||||
| NPI: | 1184975716 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YADKIN HOME PLACE SIX INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1723 | ||||||||
| Address2: | |||||||||
| City: | YADKINVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270551723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366798201 | ||||||||
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| Practice Location | |||||||||
| Address1: | 160 RIVER RD | ||||||||
| Address2: | |||||||||
| City: | BOONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270118338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365514045 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2012 | ||||||||
| LastUpdateDate: | 09/22/2012 | ||||||||
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| AuthorizedOfficialLastName: | CARLTON | ||||||||
| AuthorizedOfficialFirstName: | JERRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3366798201 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320900000X | MHL-099-027 | NC | Y | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
No ID Information.