Healthcare Provider Details

I. General information

NPI: 1942483938
Provider Name (Legal Business Name): MONET HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

6701 LITCHFORD RD
RALEIGH NC
27615-7112
US

IV. Provider business mailing address

PO BOX 41452
RALEIGH NC
27629-1452
US

V. Phone/Fax

Practice location:
  • Phone: 919-798-8638
  • Fax: 919-874-0531
Mailing address:
  • Phone: 919-798-8638
  • Fax: 919-874-0531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL092631
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberMHL092631
License Number StateNC

VIII. Authorized Official

Name: MRS. CHARLMAYNE SEABERRY ALSTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-798-8638