Healthcare Provider Details

I. General information

NPI: 1316800477
Provider Name (Legal Business Name): PROMISED PATH LIVING AND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 BRICES STORE ROAD
ROSE HILL NC
28458
US

IV. Provider business mailing address

210 E MAIN ST
ROSE HILL NC
28458-7422
US

V. Phone/Fax

Practice location:
  • Phone: 910-524-3070
  • Fax:
Mailing address:
  • Phone: 910-524-3070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGELA BONEY
Title or Position: ADMINISTRATOR
Credential: DR.
Phone: 910-524-3070