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General NPI Number Information
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NPI Number | 1386806008
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Entity Type | Organization
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Legal Business Name | EMMANUEL RESIDENTIAL FACILITY INC
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 03/17/2015
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Provider Practice Location Address
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Address Line | 3300 PINETREE LANE
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City | GREENVILLE
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State | NC
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Zip | 27858-1002
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Country | US
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Telephone | 252-355-4131
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Fax | 252-355-4337
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Provider Business Mailing Address
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Address Line | 2927 LANDING CIR
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City | GRIMESLAND
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State | NC
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Zip | 27837-9512
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Country | US
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Telephone | 252-752-6353
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Fax | 252-355-4337
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JAMES E HARRIS
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Credential |
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Telephone | 252-341-4353
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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 | MHL074152
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License Number State | NC
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