Provider Demographics
NPI:1659030294
Name:CAPE FEAR GROUP HOMES, INC.
Entity Type:Organization
Organization Name:CAPE FEAR GROUP HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEYANA
Authorized Official - Middle Name:LATRISE
Authorized Official - Last Name:MAPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-251-2555
Mailing Address - Street 1:PO BOX 4203
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28406-1203
Mailing Address - Country:US
Mailing Address - Phone:910-251-2555
Mailing Address - Fax:910-251-2555
Practice Address - Street 1:102 OLD EASTWOOD RD STE D2-9
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-0500
Practice Address - Country:US
Practice Address - Phone:910-251-2555
Practice Address - Fax:910-251-2555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPE FEAR GROUP HOMES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health