MEDICARE: HEARTSTONE HOME, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
3	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1225997034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTSTONE HOME, LLC

Provider Business Mailing Address
First Line	:	109 N CENTER ST
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27530-3620
Country	:	US
Telephone Number	:	919-648-7240
Fax Number	:

Provider Business Practice Location Address
First Line	:	406 MERCER ST
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27530-1338
Country	:	US
Telephone Number	:	919-648-7240
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MAURICIO HOWELL
Credential	:
Telephone Number	:	919-648-7240

Provider Enumeration Date	:	01/17/2026
Last Update Date	:	01/17/2026

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