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General NPI Number Information
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NPI Number | 1760519201
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Entity Type | Organization
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Legal Business Name | GAVIN & DOWNEY HEAVENLY LIVING HOME II
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 107 HARRISON RD
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City | NORLINA
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State | NC
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Zip | 27563-9558
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Country | US
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Telephone | 252-456-2998
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Fax | 252-456-2027
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Provider Business Mailing Address
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Address Line | 119 DOWNEY RD
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City | NORLINA
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State | NC
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Zip | 27563-9555
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Country | US
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Telephone | 252-456-9996
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Fax | 252-456-2027
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Authorized Official
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Title or Position | OWNER
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Name | MS. ANN LOIS GAVIN
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Credential |
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Telephone | 252-456-9996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL-093-041
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License Number State | NC
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