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General NPI Number Information
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NPI Number | 1740804111
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Entity Type | Organization
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Legal Business Name | HAPPY HEARTS GROUP HOME
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Dates
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Enumeration Date | 06/02/2020
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 6255 BURLINGTON RD
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City | GIBSONVILLE
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State | NC
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Zip | 27249-8783
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Country | US
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Telephone | 336-944-7370
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 334
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City | WHITSETT
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State | NC
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Zip | 27377-0334
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Country | US
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Telephone | 336-944-7370
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS LUCINDA MARIE DAVIS
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Credential |
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Telephone | 336-944-7370
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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