Provider Demographics
NPI:1518127315
Name:STACY DAVENPORT-BAIRD DBA WELCOME HOME GROUP HOME
Entity Type:Organization
Organization Name:STACY DAVENPORT-BAIRD DBA WELCOME HOME GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:VEE
Authorized Official - Last Name:DAVENPORT-BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-813-5557
Mailing Address - Street 1:1522 GLEN EAGLES CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27856-9585
Mailing Address - Country:US
Mailing Address - Phone:252-813-5557
Mailing Address - Fax:
Practice Address - Street 1:1522 GLEN EAGLES CT
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-9585
Practice Address - Country:US
Practice Address - Phone:252-813-5557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-15
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7806033Medicaid
NCMHL-064-088OtherNC DHSR