Provider Demographics
NPI:1366639916
Name:GRANDFATHER HOME FOR CHILDREN - MULBERRY
Entity Type:Organization
Organization Name:GRANDFATHER HOME FOR CHILDREN - MULBERRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SWINKOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-898-5465
Mailing Address - Street 1:465 MULBERRY BRANCH ROAD
Mailing Address - Street 2:
Mailing Address - City:CULOWHEE
Mailing Address - State:NC
Mailing Address - Zip Code:28723
Mailing Address - Country:US
Mailing Address - Phone:828-293-9210
Mailing Address - Fax:828-293-9216
Practice Address - Street 1:465 MULBERRY BRANCH ROAD
Practice Address - Street 2:
Practice Address - City:CULOWHEE
Practice Address - State:NC
Practice Address - Zip Code:28723
Practice Address - Country:US
Practice Address - Phone:828-293-9210
Practice Address - Fax:828-293-9216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-050-047320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness