Organization · Type 2 NPI

Fayetteville Street Community Living Home

Intellectual and/or Developmental Disabilities Residential Treatment Facility · Durham, NC

NPI number 1295998029 Active

Practice location

111 N Maple St
Durham, NC 27703-3021

Fax (919) 596-0645

Specialties and licenses

Taxonomy	Code	License
Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary	320600000X	MHL032445 (NC)

Intellectual and/or Developmental Disabilities Residential Treatment Facility: A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.

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About NPI 1295998029

Fayetteville Street Community Living Home's National Provider Identifier is 1295998029, issued on Jul 2, 2008. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Residential Treatment Facility (320600000X), and the practice location is in Durham, NC. The record was last updated on Dec 12, 2013.