=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114225554
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEND A HELPING HAND, INC #2
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2011
-----------------------------------------------------
Last Update Date | 03/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 304 RILEY ST
-----------------------------------------------------
City | RAEFORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28376-5765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-669-4181
-----------------------------------------------------
Fax | 919-552-3610
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 304 RILEY ST
-----------------------------------------------------
City | RAEFORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28376-5765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-669-4181
-----------------------------------------------------
Fax | 919-552-3610
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. DUBORIS JAMES PETERKIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-669-4181
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | MHL-047-138
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------