Provider Demographics
NPI:1063563989
Name:CHRISMAN ADULT HOME, INC.
Entity type:Organization
Organization Name:CHRISMAN ADULT HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHRISMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:828-286-4887
Mailing Address - Street 1:1366 COOPERS GAP RD
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-8661
Mailing Address - Country:US
Mailing Address - Phone:828-286-4887
Mailing Address - Fax:828-288-0398
Practice Address - Street 1:1366 COOPERS GAP RD
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-8661
Practice Address - Country:US
Practice Address - Phone:828-286-4887
Practice Address - Fax:828-288-0398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27G5600C320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities