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General NPI Number Information
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NPI Number | 1912106873
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Entity Type | Organization
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Legal Business Name | EMMANUEL RESIDENTIAL & BEHAVIORAL SERVICES
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 113 W FIRETOWER RD STE K
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City | WINTERVILLE
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State | NC
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Zip | 28590-8414
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Country | US
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Telephone | 252-756-4666
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Fax | 252-355-4337
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Provider Business Mailing Address
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Address Line | 2927 LANDING CIRCLE
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City | GRIMESLAND
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State | NC
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Zip | 27837-9512
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Country | US
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Telephone | 252-752-6353
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Fax | 252-355-4337
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES E HARRIS
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Credential |
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Telephone | 252-752-6353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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