Provider Demographics
NPI:1811573025
Name:CAPE FEAR GROUP HOMES, INC.
Entity type:Organization
Organization Name:CAPE FEAR GROUP HOMES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-207-1545
Mailing Address - Street 1:PO BOX 4203
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28406-1203
Mailing Address - Country:US
Mailing Address - Phone:910-251-2555
Mailing Address - Fax:910-251-0590
Practice Address - Street 1:28 BEAUREGARD DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6702
Practice Address - Country:US
Practice Address - Phone:910-251-2555
Practice Address - Fax:910-251-0590
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPE FEAR GROUP HOMES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-19
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities