Provider Demographics
NPI:1487028254
Name:SISTERLY LOVE
Entity Type:Organization
Organization Name:SISTERLY LOVE
Other - Org Name:SISTERLY LOVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RESIDENTIAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-476-7880
Mailing Address - Street 1:170 CLUB POND RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-9291
Mailing Address - Country:US
Mailing Address - Phone:910-476-7880
Mailing Address - Fax:910-904-0728
Practice Address - Street 1:170 CLUB POND RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-9291
Practice Address - Country:US
Practice Address - Phone:910-904-0728
Practice Address - Fax:910-904-0728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities