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General NPI Number Information
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NPI Number | 1508139213
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Entity Type | Organization
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Legal Business Name | OPEN HEARTS
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Dates
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Enumeration Date | 02/13/2012
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 509 BEASLEY ST
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City | PRINCEVILLE
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State | NC
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Zip | 27886-5414
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Country | US
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Telephone | 252-641-4005
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Fax | 252-641-4005
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Provider Business Mailing Address
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Address Line | 509 BEASLEY ST
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City | PRINCEVILLE
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State | NC
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Zip | 27886-5414
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Country | US
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Telephone | 252-641-4005
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Fax | 252-641-4005
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Authorized Official
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Title or Position | OWNER
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Name | ALBERT R TELFAIR
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Credential |
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Telephone | 252-641-4005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | MHL033107
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License Number State | NC
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