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General NPI Number Information
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NPI Number | 1679802920
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Entity Type | Organization
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Legal Business Name | PRECIOUS HAVEN, INC.
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Dates
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Enumeration Date | 12/16/2009
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Last Update Date | 12/16/2009
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Provider Practice Location Address
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Address Line | 7762 HAZELWOOD AVE
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-6246
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Country | US
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Telephone | 910-868-6092
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Fax | 910-868-8882
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Provider Business Mailing Address
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Address Line | PO BOX 25821
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-5013
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Country | US
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Telephone | 910-868-6092
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Fax | 910-868-8882
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | MRS. MELISSA M. MCALLISTER
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Credential |
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Telephone | 910-868-6092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | MHL-026-673
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License Number State | NC
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