Provider Demographics
NPI:1366679268
Name:SANCTUARY HOUSE
Entity Type:Organization
Organization Name:SANCTUARY HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENZO-SCHIBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-275-7896
Mailing Address - Street 1:PO BOX 21141
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27420-1141
Mailing Address - Country:US
Mailing Address - Phone:336-275-7896
Mailing Address - Fax:336-346-1748
Practice Address - Street 1:315 N SPRING ST APT A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6071
Practice Address - Country:US
Practice Address - Phone:336-275-7896
Practice Address - Fax:336-346-1748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health