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General NPI Number Information
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NPI Number | 1114442258
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Entity Type | Organization
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Legal Business Name | IDELLA'S HOME
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Dates
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Enumeration Date | 08/10/2017
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 1015 F8 SPRING FOREST RD
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City | GREENVILLE
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State | NC
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Zip | 27834
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Country | US
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Telephone | 252-213-6081
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Fax |
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Provider Business Mailing Address
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Address Line | 912 PRISTINE LN
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City | ROLESVILLE
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State | NC
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Zip | 27571-9307
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Country | US
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Telephone | 252-213-6081
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EUNICE HART
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Credential | PRESIDENT
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Telephone | 252-213-6081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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