Healthcare Provider Details

I. General information

NPI: 1124396056
Provider Name (Legal Business Name): HEALTHY LIVING GROUP SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N FRANKLIN ST
WHITEVILLE NC
28472-2735
US

IV. Provider business mailing address

805 N FRANKLIN ST
WHITEVILLE NC
28472-2735
US

V. Phone/Fax

Practice location:
  • Phone: 910-641-0000
  • Fax: 910-641-0001
Mailing address:
  • Phone: 910-641-0000
  • Fax: 910-641-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number01980
License Number StateNC

VIII. Authorized Official

Name: AUDREY BELLAMY
Title or Position: DIRECTOR
Credential:
Phone: 910-641-0000