Healthcare Provider Details

I. General information

NPI: 1578455622
Provider Name (Legal Business Name): CORENIA HARMONY NEXUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 SMITH HARBOUR DR
DENVER NC
28037-8086
US

IV. Provider business mailing address

PO BOX 494
HARRISBURG NC
28075-0494
US

V. Phone/Fax

Practice location:
  • Phone: 980-334-1848
  • Fax:
Mailing address:
  • Phone: 980-334-1848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. CONSTANCE GLASS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 980-334-1848