Provider Demographics
NPI:1265598692
Name:CANDII HOMES
Entity type:Organization
Organization Name:CANDII HOMES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEEL
Authorized Official - Suffix:
Authorized Official - Credentials:MHL-082-056
Authorized Official - Phone:910-627-4796
Mailing Address - Street 1:404 EAST POWELL ST
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:910-627-4796
Mailing Address - Fax:910-260-4195
Practice Address - Street 1:513 RALEIGH RD, SUITE D
Practice Address - Street 2:404 EAST POWELL ST
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328
Practice Address - Country:US
Practice Address - Phone:910-260-4195
Practice Address - Fax:910-260-4195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-082-056320600000X
NCMHL-085-056251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805715Medicaid
NC8301828Medicaid