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General NPI Number Information
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NPI Number | 1962813634
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Entity Type | Organization
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Legal Business Name | ST. GERARD HOUSE
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 620 OAKLAND ST
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City | HENDERSONVILLE
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State | NC
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Zip | 28791-3646
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Country | US
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Telephone | 828-693-4223
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Fax | 828-693-6144
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Provider Business Mailing Address
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Address Line | 620 OAKLAND ST
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City | HENDERSONVILLE
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State | NC
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Zip | 28791-3646
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Country | US
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Telephone | 828-693-4223
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Fax | 828-693-6144
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. CAROLINE LONG
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Credential |
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Telephone | 828-693-4223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-09-5881
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License Number State | NC
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