MEDICARE: GO HARD INSTITUTE AND RESORSE GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	21616	NC

General Provider Information

NPI Number	:	1184088338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GO HARD INSTITUTE AND RESORSE GROUP

Provider Business Mailing Address
First Line	:	3211 BRAMER DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-1603
Country	:	US
Telephone Number	:	919-850-9960
Fax Number	:	919-850-9961

Provider Business Practice Location Address
First Line	:	3211 BRAMER DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-1603
Country	:	US
Telephone Number	:	919-850-9960
Fax Number	:	919-850-9961

Authorized Official
Title or Position	:	REGIONAL DIRECTOR
Name	:	MISS DARLENE C WRIGHT
Credential	:
Telephone Number	:	919-850-9960

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	04/13/2016

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