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General NPI Number Information
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NPI Number | 1801928395
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Entity Type | Organization
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Legal Business Name | NAOMI'S GROUP HOMES
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Dates
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Enumeration Date | 03/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1836 CONOVER DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4562
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Country | US
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Telephone | 910-424-6071
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 478
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City | FAYETTEVILLE
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State | NC
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Zip | 28302-0478
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Country | US
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Telephone | 910-424-6071
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | NAOMI WILLIAMS
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Credential |
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Telephone | 910-822-4736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | MHL 026 652
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | MHL 026 649
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | MHL 026 664
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | MHL 026 651
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License Number State | NC
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