# GAVIN & DOWNEY HEAVENLY LIVING HOME 1

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114125622
- **Authorized official:** MS. ANN LOIS GAVIN (OWNER)
- **Authorized official phone:** (252) 456-9996

## Contact information

- **Practice address:** 426 ROOKER DAIRY RD, NORLINA, NC 27563-9544
- **Practice address phone:** (252) 456-9996
- **Practice address fax:** (252) 456-2027
- **Mailing address:** 426 ROOKER DAIRY RD, NORLINA, NC 27563-9544
- **Mailing address phone:** (252) 456-9996
- **Mailing address fax:** (252) 456-2027

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | MHL-093-036 | NC | Yes |

## Other

- **Enumeration date:** 07/05/2007
- **Last updated:** 08/28/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7805804 | — | NC |