Provider Demographics
NPI:1154689107
Name:CHATHAM COUNTY GROUP HOMES, INC.
Entity Type:Organization
Organization Name:CHATHAM COUNTY GROUP HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-742-2510
Mailing Address - Street 1:217 E BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-3403
Mailing Address - Country:US
Mailing Address - Phone:919-742-2510
Mailing Address - Fax:919-742-3984
Practice Address - Street 1:251 LYNNBROOK DR
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-3403
Practice Address - Country:US
Practice Address - Phone:919-742-2510
Practice Address - Fax:919-742-3984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-019-034320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities