Healthcare Provider Details

I. General information

NPI: 1699937797
Provider Name (Legal Business Name): HEROS HOUSE OF ROYAL DREAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 GARCES CIR
PFAFFTOWN NC
27040-9470
US

IV. Provider business mailing address

2701 GARCES CIR
PFAFFTOWN NC
27040-9470
US

V. Phone/Fax

Practice location:
  • Phone: 336-924-0840
  • Fax:
Mailing address:
  • Phone: 336-924-0840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateNC

VIII. Authorized Official

Name: MARC ANTOINE RAYE
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 336-480-8612