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General NPI Number Information
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NPI Number | 1588702484
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Entity Type | Organization
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Legal Business Name | SWELTON HEIGHTS HAVEN
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 07/09/2008
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Provider Practice Location Address
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Address Line | 1321 MCDEARMAN ST
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2640
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Country | US
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Telephone | 252-446-4924
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Fax | 252-446-0612
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Provider Business Mailing Address
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Address Line | 1321 MCDEARMAN ST
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2640
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Country | US
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Telephone | 252-446-4924
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Fax | 252-446-0612
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. GAIL DIANNE TITUES'JONES
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Credential |
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Telephone | 252-446-4924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | FCL064003
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License Number State | NC
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