Provider Demographics
NPI:1043334212
Name:CHERRY'S GROUP HOME
Entity Type:Organization
Organization Name:CHERRY'S GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALPHONSO
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-377-7081
Mailing Address - Street 1:108 HARMON STREET
Mailing Address - Street 2:
Mailing Address - City:AULANDER
Mailing Address - State:NC
Mailing Address - Zip Code:27805-0506
Mailing Address - Country:US
Mailing Address - Phone:252-345-1353
Mailing Address - Fax:252-345-4125
Practice Address - Street 1:108 HARMON STREET
Practice Address - Street 2:
Practice Address - City:AULANDER
Practice Address - State:NC
Practice Address - Zip Code:27805-0506
Practice Address - Country:US
Practice Address - Phone:252-345-1353
Practice Address - Fax:252-345-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-008-0043104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness