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General NPI Number Information
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NPI Number | 1053595546
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Entity Type | Organization
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Legal Business Name | HILLS DDA GROUP HOME INC
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Dates
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Enumeration Date | 12/20/2007
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 2017 EAST RIDGE CIR
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City | KINSTON
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State | NC
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Zip | 28501
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Country | US
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Telephone | 252-522-4869
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5425 2017 EAST RIDGE CIRCLE
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City | KINSTON
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State | NC
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Zip | 28501
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Country | US
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Telephone | 252-522-4869
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Fax | 252-522-4869
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. ALICETINE P ROUSE
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Credential |
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Telephone | 252-522-4869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MHL054111
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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