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General NPI Number Information
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NPI Number | 1366677361
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Entity Type | Organization
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Legal Business Name | LAKEVIEW
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 05/19/2009
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Provider Practice Location Address
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Address Line | 103 LAKEVIEW DR
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City | GOLDSBORO
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State | NC
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Zip | 27530-1125
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Country | US
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Telephone | 919-734-0266
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Fax | 919-734-9926
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Provider Business Mailing Address
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Address Line | PO BOX 1017
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City | GOLDSBORO
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State | NC
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Zip | 27533-1017
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Country | US
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Telephone | 919-734-0266
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Fax | 919-734-9926
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DIANE HARRISON
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Credential |
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Telephone | 919-734-0266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | MHL-096-092
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License Number State | NC
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