Provider Demographics
NPI:1043520513
Name:THE UMBRELLA GROUP LLC
Entity Type:Organization
Organization Name:THE UMBRELLA GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRISHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-697-9310
Mailing Address - Street 1:5710 K HIGH POINT RD
Mailing Address - Street 2:STE 258
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-8554
Mailing Address - Country:US
Mailing Address - Phone:336-697-9310
Mailing Address - Fax:336-697-5423
Practice Address - Street 1:4308 BRITLEY COURT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-8554
Practice Address - Country:US
Practice Address - Phone:336-697-9310
Practice Address - Fax:336-697-5423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL041903320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities