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General NPI Number Information
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NPI Number | 1982701900
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Entity Type | Organization
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Legal Business Name | DIYAH'S HOME INC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 10/29/2007
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Provider Practice Location Address
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Address Line | 218 UNIVERSITY AVE
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-3442
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Country | US
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Telephone | 910-497-8599
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Fax | 910-436-5928
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Provider Business Mailing Address
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Address Line | PO BOX 2744
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City | FAYETTEVILLE
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State | NC
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Zip | 28302-2744
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Country | US
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Telephone | 910-497-8599
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Fax | 910-436-5928
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | DAVID HAQQ
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Credential |
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Telephone | 910-978-8599
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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-026-583
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License Number State | NC
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