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General NPI Number Information
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NPI Number | 1790581999
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Entity Type | Organization
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Legal Business Name | GREATER HARVEST HOMES LLC
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 106 E RUBY AVE
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City | GASTONIA
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State | NC
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Zip | 28054-5463
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Country | US
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Telephone | 704-671-2101
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Fax |
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Provider Business Mailing Address
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Address Line | 3104 HIGHGATE DR
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City | FORT MILL
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State | SC
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Zip | 29715-7304
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Country | US
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Telephone | 704-798-6105
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CRYSTAL LOUISE COLLINS
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Credential |
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Telephone | 704-798-6105
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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 |
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License Number State |
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