Healthcare Provider Details

I. General information

NPI: 1881896660
Provider Name (Legal Business Name): PHILIP HOUSE THERAPEUTIC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 WEST MILLBROOK ROAD SUITE 201
RALEIGH NC
27609
US

IV. Provider business mailing address

5801 CHERRYRAIN CT
RALEIGH NC
27610-5586
US

V. Phone/Fax

Practice location:
  • Phone: 919-676-5840
  • Fax: 919-676-5839
Mailing address:
  • Phone: 919-676-5840
  • Fax: 919-676-5839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberMHL 092-644
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL 092-644
License Number StateNC

VIII. Authorized Official

Name: MS. ROSEMARY ANAYO NJOKU
Title or Position: CEO/ADMINISTRATIVE
Credential: B.A.,
Phone: 919-395-5227