Provider Demographics
NPI:1154647147
Name:WINSTEAD SUPERVISED LIVING
Entity Type:Organization
Organization Name:WINSTEAD SUPERVISED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:H
Authorized Official - Last Name:WINSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-599-4936
Mailing Address - Street 1:2869 MCGHEES MILL RD
Mailing Address - Street 2:
Mailing Address - City:SEMORA
Mailing Address - State:NC
Mailing Address - Zip Code:27343-9189
Mailing Address - Country:US
Mailing Address - Phone:336-599-4936
Mailing Address - Fax:
Practice Address - Street 1:7300 VIRGILINA RD
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27574-8394
Practice Address - Country:US
Practice Address - Phone:336-599-6938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities