Provider Demographics
NPI:1841336062
Name:ROUSE'S GROUP HOME, INC.
Entity type:Organization
Organization Name:ROUSE'S GROUP HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-427-0609
Mailing Address - Street 1:5949 NC 135
Mailing Address - Street 2:
Mailing Address - City:STONEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27048-8479
Mailing Address - Country:US
Mailing Address - Phone:336-427-2532
Mailing Address - Fax:336-427-2978
Practice Address - Street 1:5949 NC 135
Practice Address - Street 2:
Practice Address - City:STONEVILLE
Practice Address - State:NC
Practice Address - Zip Code:27048-8479
Practice Address - Country:US
Practice Address - Phone:336-427-8562
Practice Address - Fax:336-427-2978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-079-047315P00000X
NCMHL-079-004315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC340611XMedicaid
NC3406301Medicaid