Healthcare Provider Details

I. General information

NPI: 1245457258
Provider Name (Legal Business Name): AMANI RESIDENTIAL HUMAN SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 ROBERSON DR
WILLIAMSTON NC
27892-7607
US

IV. Provider business mailing address

PO BOX 833
WILLIAMSTON NC
27892-0833
US

V. Phone/Fax

Practice location:
  • Phone: 252-792-7859
  • Fax:
Mailing address:
  • Phone: 252-508-6581
  • Fax: 252-508-4769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL058022
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-058-022
License Number StateNC

VIII. Authorized Official

Name: JEFFERY NMN ROBERTS
Title or Position: DIRECTOR
Credential:
Phone: 252-508-6581