Provider Demographics
NPI:1699946301
Name:PROFESSIONAL GROUP LIVING,LLC
Entity type:Organization
Organization Name:PROFESSIONAL GROUP LIVING,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALKA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCK MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-475-6124
Mailing Address - Street 1:122 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-4829
Mailing Address - Country:US
Mailing Address - Phone:919-735-2211
Mailing Address - Fax:
Practice Address - Street 1:122 S. CENTER STREET
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530
Practice Address - Country:US
Practice Address - Phone:919-735-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health