Moda Human Services L.l.c
NPI #1013158039 in Winston Salem, North Carolina
Provider Information
- NPI Number
- 1013158039
- Entity Type
- Organization
- Organization Name
- Moda Human Services L.l.c
- Primary Specialty
- Community Based Residential Treatment Facility, Mental Illness
- Enumeration Date
- Mar 20, 2009
- Last Updated
- Mar 20, 2009
Practice Location
- Address
- 4420 EDREM AVE
- City
- Winston Salem
- State
- North Carolina
- ZIP Code
- 27101-2108
- Phone
- (336) 725-9395
Authorized Official
- Name
- MISS MALEBOGO NANZALA SAMUZALA
- Title
- OWNER
- Phone
- (336) 705-0643
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community Based Residential Treatment Facility, Mental Illness |
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