Healthcare Provider Details

I. General information

NPI: 1396547881
Provider Name (Legal Business Name): HOUSE OF HAGAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3269 FOREST CREEK CT
GASTONIA NC
28052-6092
US

IV. Provider business mailing address

PO BOX 972
LOWELL NC
28098-0972
US

V. Phone/Fax

Practice location:
  • Phone: 704-675-1012
  • Fax:
Mailing address:
  • Phone: 704-675-1012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: IVEY TAYLOR
Title or Position: DIRECTOR
Credential:
Phone: 704-675-1012