Provider Demographics
NPI:1306964242
Name:DEE & G ENRICHMENT CENTER #3
Entity type:Organization
Organization Name:DEE & G ENRICHMENT CENTER #3
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:YANCEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-266-4909
Mailing Address - Street 1:321 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-8300
Mailing Address - Country:US
Mailing Address - Phone:336-266-4909
Mailing Address - Fax:336-228-6447
Practice Address - Street 1:321 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-8300
Practice Address - Country:US
Practice Address - Phone:336-266-4909
Practice Address - Fax:336-222-8338
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEE AND G ENRICHMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-27
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMHL001132Medicaid