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General NPI Number Information
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NPI Number | 1326284928
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Entity Type | Organization
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Legal Business Name | HAWTHORN HOUSE
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Dates
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Enumeration Date | 01/02/2009
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Last Update Date | 01/02/2009
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Provider Practice Location Address
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Address Line | 1025 HWY 45 NORTH
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City | MERRY HILL
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State | NC
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Zip | 27957-9408
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Country | US
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Telephone | 252-356-4141
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 HWY 45 NORTH
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City | MERRY HILL
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State | NC
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Zip | 27957
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Country | US
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Telephone | 252-356-4141
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BARBARA JEAN DAVENPORT
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Credential |
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Telephone | 252-209-6986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | FCL 008-025
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License Number State | NC
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