Provider Demographics
NPI:1861682064
Name:CANDII HOMES INC
Entity Type:Organization
Organization Name:CANDII HOMES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEEL
Authorized Official - Suffix:
Authorized Official - Credentials:MHL082056
Authorized Official - Phone:910-592-7451
Mailing Address - Street 1:100 WARSAW ROAD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-3518
Mailing Address - Country:US
Mailing Address - Phone:910-592-7451
Mailing Address - Fax:910-221-5479
Practice Address - Street 1:100 WARSAW ROAD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-3518
Practice Address - Country:US
Practice Address - Phone:910-592-7451
Practice Address - Fax:910-221-5479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-082-056251S00000X
NCMHL-082056320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805715Medicaid
NC8301828Medicaid