Healthcare Provider Details

I. General information

NPI: 1609058403
Provider Name (Legal Business Name): HENDERSON'S HOUSE OF HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 OCEAN CT DURHAM
DURHAM NC
27704-2287
US

IV. Provider business mailing address

5 OCEAN CT DURHAM
DURHAM NC
27704-2287
US

V. Phone/Fax

Practice location:
  • Phone: 919-479-5073
  • Fax: 919-479-5073
Mailing address:
  • Phone: 919-479-5073
  • Fax: 919-479-5073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. CYNTHIA TERESA HENDERSON
Title or Position: OWNER
Credential:
Phone: 919-479-5073