Provider Demographics
NPI:1477858678
Name:ENOCH GROUP HOME
Entity Type:Organization
Organization Name:ENOCH GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GARNETTA
Authorized Official - Middle Name:ENOCH
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-506-6641
Mailing Address - Street 1:PO BOX 3062
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-0062
Mailing Address - Country:US
Mailing Address - Phone:336-506-6641
Mailing Address - Fax:336-226-7405
Practice Address - Street 1:433 N LOGAN ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2339
Practice Address - Country:US
Practice Address - Phone:336-506-6641
Practice Address - Fax:336-226-7405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-001-2073104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness