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General NPI Number Information
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NPI Number | 1407078165
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Entity Type | Organization
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Legal Business Name | D.H.D. GROUP HOME
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1229 BERKELEY ST
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City | DURHAM
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State | NC
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Zip | 27705-3530
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Country | US
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Telephone | 919-286-1927
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Fax |
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Provider Business Mailing Address
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Address Line | 1229 BERKELEY ST
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City | DURHAM
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State | NC
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Zip | 27705-3530
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Country | US
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Telephone | 919-286-1927
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DERIK LEE ABNEY
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Credential |
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Telephone | 919-608-5267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | MHLO32370
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License Number State | NC
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