Provider Demographics
NPI: | 1477762904 |
---|---|
Name: | P&W GROUP |
Entity Type: | Organization |
Organization Name: | P&W GROUP |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | FACILITY DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JAMES |
Authorized Official - Middle Name: | EDWARD |
Authorized Official - Last Name: | WATKINS |
Authorized Official - Suffix: | JR |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 252-438-2510 |
Mailing Address - Street 1: | 2636 WARRENTON RD |
Mailing Address - Street 2: | |
Mailing Address - City: | HENDERSON |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27537-9355 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2636 WARRENTON RD |
Practice Address - Street 2: | |
Practice Address - City: | HENDERSON |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27537-9355 |
Practice Address - Country: | US |
Practice Address - Phone: | 252-438-2510 |
Practice Address - Fax: | 252-438-3205 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-05-22 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | MHL-091-075 | 320600000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities |