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General NPI Number Information
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NPI Number | 1235395294
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Entity Type | Organization
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Legal Business Name | HOUSEOFPROSPERITY
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 118 ELLIS DR
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City | GOLDSBORO
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State | NC
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Zip | 27534-9500
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Country | US
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Telephone | 980-253-3764
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Fax |
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Provider Business Mailing Address
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Address Line | 1805 N BERKELEY BLVD
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City | GOLDSBORO
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State | NC
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Zip | 27534-3307
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Country | US
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Telephone | 919-288-1608
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Fax | 919-288-2108
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. REGINA RAYNETTE YOUNG
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Credential |
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Telephone | 980-253-3764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | MHL-096-199
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License Number State | NC
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