OrganizationActive
Church Street Group Home LLC
NPI 1821389776 · Assisted Living Facility (Mental Illness) · Burlington, NC
Provider details
- NPI number
- 1821389776
- Entity type
- Organization
- Primary specialty
- Assisted Living Facility (Mental Illness)Nursing & Custodial Care Facilities
- Authorized official
- Mittie Fuller, President/Owner
- License
- MHL-001-213 (NC)
Practice location
1017 S Church St
Burlington, NC 27215-5045
Phone: (336) 227-1613
Fax: (336) 227-1613
Mailing address
Po Box 1996
Burlington, NC 27216-1996
Registry dates
- Enumerated
- 2011-04-27
- Last updated
- 2011-04-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.