NPI 1033204300

Miss Daisy's Gentlemen of the Future INC.

Organisation Intellectual and/or Developmental Disabilities Residential Treatment Facility Wilson, NC

Practice location

Address: 304 Fairview Ave SW, Wilson, NC 27893-4817
Phone: (252) 293-4683
Fax: (252) 291-6962

Authorised official

Name: Tonya Fuller Johnson
Title: Director/Qualified Professional
Phone: (252) 363-5446

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X Licence MHL098100 (NC)

Other Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in North Carolina →

Registry record

NPI: 1033204300
Entity type: Organization
NPI issued: 4 Oct 2006
Record last updated: 22 Aug 2020

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.