Healthcare Provider Details

I. General information

NPI: 1730576992
Provider Name (Legal Business Name): HARRISON GROUP HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 FERNBROOK RD
RALEIGH NC
27610-3507
US

IV. Provider business mailing address

2609 FERNBROOK RD
RALEIGH NC
27610-3507
US

V. Phone/Fax

Practice location:
  • Phone: 919-301-8044
  • Fax: 919-615-3267
Mailing address:
  • Phone: 919-301-8044
  • Fax: 919-615-3267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMHL-092-899
License Number StateNC

VIII. Authorized Official

Name: MR. UCHENNA HARRISON ENYINNAYA
Title or Position: ADMINISTRATOR
Credential:
Phone: 919-301-8044