Provider Demographics
NPI:1417176991
Name:LILY OF THE VALLEY, INC.
Entity Type:Organization
Organization Name:LILY OF THE VALLEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-554-2221
Mailing Address - Street 1:4107 MAYNARD CIR
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:27525-7576
Mailing Address - Country:US
Mailing Address - Phone:919-528-7285
Mailing Address - Fax:919-528-7285
Practice Address - Street 1:4107 MAYNARD CIR
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:NC
Practice Address - Zip Code:27525-7576
Practice Address - Country:US
Practice Address - Phone:919-528-7285
Practice Address - Fax:919-528-7285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-092660320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities