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General NPI Number Information
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NPI Number | 1295329282
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Entity Type | Organization
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Legal Business Name | HEALING HOUSE 1 RESIDENTIAL CARE, LLC
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Dates
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Enumeration Date | 02/22/2021
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Last Update Date | 02/22/2021
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Provider Practice Location Address
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Address Line | 107 NORTHWIND COURT
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City | WARNER ROBINS
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State | GA
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Zip | 31093
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Country | US
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Telephone | 478-731-2895
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Fax | 478-302-5767
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Provider Business Mailing Address
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Address Line | 107 NORTHWIND COURT
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City | WARNER ROBINS
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State | GA
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Zip | 31093
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Country | US
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Telephone | 478-731-2895
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Fax | 478-302-5767
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Authorized Official
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Title or Position | OWNER
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Name | MS. ESSIE NOVELLA DAVIS
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Credential |
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Telephone | 478-731-2895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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