Provider Demographics
NPI:1689807448
Name:EMMANUEL MINISTRIES INTERNATIONAL, INC.
Entity Type:Organization
Organization Name:EMMANUEL MINISTRIES INTERNATIONAL, INC.
Other - Org Name:HOMES OF EMMANUEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MT(ASCP)SH
Authorized Official - Phone:336-617-6510
Mailing Address - Street 1:PO BOX 1713
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-1713
Mailing Address - Country:US
Mailing Address - Phone:336-617-6510
Mailing Address - Fax:336-617-6510
Practice Address - Street 1:1005 BRUSHY FORK DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-8061
Practice Address - Country:US
Practice Address - Phone:336-617-6510
Practice Address - Fax:336-617-6510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL041913320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities