Whalio Doctors

NPI 1013158039

Moda Human Services L.L.C

Organisation Mental Illness Community Based Residential Treatment Facility Winston Salem, NC

Practice location

Address
4420 Edrem Ave, Winston Salem, NC 27101-2108
Phone
(336) 725-9395
Fax
(336) 724-9365
Mailing address
PO Box 1073, Winston Salem, NC 27102-1073

Authorised official

Name
Malebogo Nanzala Samuzala
Title
Owner
Phone
(336) 705-0643

Registered specialties

Mental Illness Community Based Residential Treatment Facility Primary
Residential Treatment Facilities Taxonomy 320800000X

Registry record

NPI
1013158039
Entity type
Organization
NPI issued
20 Mar 2009
Record last updated
20 Mar 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.