Provider Demographics
NPI:1851624910
Name:LEVAN PLACE
Entity Type:Organization
Organization Name:LEVAN PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-520-7687
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27323-0393
Mailing Address - Country:US
Mailing Address - Phone:336-520-7687
Mailing Address - Fax:
Practice Address - Street 1:4278 ASHLAND RD
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-0509
Practice Address - Country:US
Practice Address - Phone:336-520-7687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No347C00000XTransportation ServicesPrivate Vehicle