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General NPI Number Information
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NPI Number | 1487265682
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Entity Type | Organization
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Legal Business Name | DA-QUEENS HOME
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Dates
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Enumeration Date | 08/11/2020
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Last Update Date | 04/02/2023
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Provider Practice Location Address
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Address Line | 601 EASTERN AVE
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City | ROCKY MOUNT
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State | NC
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Zip | 27801-5856
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Country | US
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Telephone | 919-395-6027
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Fax | 919-329-7640
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Provider Business Mailing Address
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Address Line | 295 ADAMS POINT DR
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City | GARNER
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State | NC
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Zip | 27529-6507
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Country | US
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Telephone | 919-395-6027
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Fax | 919-329-7640
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Authorized Official
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Title or Position | CEO
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Name | NGOZI MARY NGWADOM
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Credential | MA
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Telephone | 919-395-6027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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