Provider Demographics
NPI:1275637852
Name:MYROVER-REESE FELLOWSHIP HOMES INC.
Entity Type:Organization
Organization Name:MYROVER-REESE FELLOWSHIP HOMES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:910-486-8718
Mailing Address - Street 1:PO BOX 64933
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-0933
Mailing Address - Country:US
Mailing Address - Phone:910-486-8718
Mailing Address - Fax:910-486-5976
Practice Address - Street 1:560 WILKES RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-3038
Practice Address - Country:US
Practice Address - Phone:910-486-8718
Practice Address - Fax:910-486-5976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL026005101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty