Provider Demographics
NPI:1689716821
Name:ROBESON COUNTY GROUP HOME, INC.
Entity Type:Organization
Organization Name:ROBESON COUNTY GROUP HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GALE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-671-0818
Mailing Address - Street 1:PO BOX 3047
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-3047
Mailing Address - Country:US
Mailing Address - Phone:910-671-0818
Mailing Address - Fax:910-671-0993
Practice Address - Street 1:2121 TURNER PL
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3256
Practice Address - Country:US
Practice Address - Phone:910-671-0818
Practice Address - Fax:910-671-0993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMEDICAID 3408377320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802611Medicaid
NC7802612Medicaid
NC3408377Medicaid
NC7802640Medicaid