Healthcare Provider Details

I. General information

NPI: 1417712670
Provider Name (Legal Business Name): BARBARA'S HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MELROSE AVE STE 100
GREENWICH CT
06830-6277
US

IV. Provider business mailing address

10130 MALLARD CREEK RD STE 343
CHARLOTTE NC
28262-6000
US

V. Phone/Fax

Practice location:
  • Phone: 203-869-1276
  • Fax:
Mailing address:
  • Phone: 704-219-4720
  • Fax: 888-323-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KEISHA MILLER
Title or Position: BILLING DIRECTOR
Credential:
Phone: 704-219-4720