Provider Demographics
NPI:1073815023
Name:HAZELS RESIDENTIAL CARE
Entity Type:Organization
Organization Name:HAZELS RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDELL
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-228-6357
Mailing Address - Street 1:3739 BOY WOOD RD
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-9141
Mailing Address - Country:US
Mailing Address - Phone:336-228-8443
Mailing Address - Fax:
Practice Address - Street 1:1010 MADISON ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-1435
Practice Address - Country:US
Practice Address - Phone:336-228-8443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-001-204320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness