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General NPI Number Information
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NPI Number | 1699937797
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Entity Type | Organization
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Legal Business Name | HEROS HOUSE OF ROYAL DREAMS
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 2701 GARCES CIR
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City | PFAFFTOWN
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State | NC
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Zip | 27040-9470
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Country | US
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Telephone | 336-924-0840
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Fax |
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Provider Business Mailing Address
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Address Line | 2701 GARCES CIR
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City | PFAFFTOWN
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State | NC
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Zip | 27040-9470
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Country | US
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Telephone | 336-924-0840
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MARC ANTOINE RAYE
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Credential |
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Telephone | 336-480-8612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | NC
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