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General NPI Number Information
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NPI Number | 1619015591
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Entity Type | Organization
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Legal Business Name | SPRINGHAVEN FCH # 2
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 09/01/2011
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Provider Practice Location Address
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Address Line | 1308 E LANE ST
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City | RALEIGH
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State | NC
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Zip | 27610-2322
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Country | US
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Telephone | 919-828-3834
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Fax | 919-496-3714
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Provider Business Mailing Address
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Address Line | 1308 E LANE ST PO BOX 25718
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City | RALEIGH
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State | NC
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Zip | 27610-2322
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Country | US
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Telephone | 919-828-3834
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Fax | 919-496-3714
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Authorized Official
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Title or Position | OWNER
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Name | MRS. GAIL DIANNE TITUES'JONES
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Credential |
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Telephone | 252-813-8416
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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 | FCL092100
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License Number State | NC
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