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General NPI Number Information
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NPI Number | 1376699819
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Entity Type | Organization
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Legal Business Name | ABUNDANCE SAFE HAVEN INC
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 915 FISKE ST
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City | DURHAM
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State | NC
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Zip | 27703-1615
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Country | US
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Telephone | 919-680-2030
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Fax |
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Provider Business Mailing Address
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Address Line | 1821 HILLANDALE RD 1B
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City | DURHAM
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State | NC
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Zip | 27705-2659
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. TERRON HORATIOUS SIMPSON SR.
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Credential |
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Telephone | 919-680-2030
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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 | MHL-032-322
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License Number State | NC
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