=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063291011
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAPPY HEARTS GROUP HOME
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2023
-----------------------------------------------------
Last Update Date | 09/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6450 BURLINGTON RD
-----------------------------------------------------
City | WHITSETT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27377-9716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-944-7370
-----------------------------------------------------
Fax | 336-603-8764
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6450 BURLINGTON RD
-----------------------------------------------------
City | WHITSETT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27377-9716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-944-7370
-----------------------------------------------------
Fax | 336-603-8764
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MISS LUCINDA M DAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-944-7370
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------