Provider Demographics
NPI:1598068900
Name:BLACKWELL'S COMMUNITY LIVING LLC
Entity type:Organization
Organization Name:BLACKWELL'S COMMUNITY LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:NEWBY
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-317-1926
Mailing Address - Street 1:509 FERNWAY DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-8850
Mailing Address - Country:US
Mailing Address - Phone:336-270-4463
Mailing Address - Fax:336-897-7564
Practice Address - Street 1:509 FERNWAY DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-8850
Practice Address - Country:US
Practice Address - Phone:336-270-4463
Practice Address - Fax:336-897-7564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health