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General NPI Number Information
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NPI Number | 1316800477
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Entity Type | Organization
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Legal Business Name | PROMISED PATH LIVING AND CARE LLC
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 455 BRICES STORE ROAD
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City | ROSE HILL
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State | NC
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Zip | 28458
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Country | US
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Telephone | 910-524-3070
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Fax |
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Provider Business Mailing Address
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Address Line | 210 E MAIN ST
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City | ROSE HILL
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State | NC
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Zip | 28458-7422
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Country | US
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Telephone | 910-524-3070
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. ANGELA BONEY
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Credential | DR.
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Telephone | 910-524-3070
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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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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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