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General NPI Number Information
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NPI Number | 1427760503
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Entity Type | Organization
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Legal Business Name | PEACEHAVEN FARM INC.
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Dates
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Enumeration Date | 12/20/2022
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Last Update Date | 12/20/2022
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Provider Practice Location Address
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Address Line | 1458 NC HIGHWAY 61
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City | WHITSETT
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State | NC
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Zip | 27377-9772
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Country | US
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Telephone | 336-449-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 1458 NC HIGHWAY 61
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City | WHITSETT
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State | NC
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Zip | 27377-9772
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Country | US
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Telephone | 336-449-9900
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF HOUSING
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Name | ADAM MICHAEL BARNES
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Credential |
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Telephone | 336-449-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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 |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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