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General NPI Number Information
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NPI Number | 1366846404
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Entity Type | Organization
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Legal Business Name | THE LOVING HOME,INC. #6
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 1903 BRIDGER ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-3913
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Country | US
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Telephone | 910-884-3896
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Fax | 910-484-0629
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Provider Business Mailing Address
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Address Line | 1903 BRIDGER ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-3913
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Country | US
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Telephone | 910-884-3896
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Fax | 910-484-0629
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DESMOND ONYE OKORIEOCH
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Credential | BS,MBA
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Telephone | 910-624-0844
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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 |
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License Number State |
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