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Organization
KIONONIA HAVEN HOMES, LLC
Active
Organization
KIONONIA HAVEN HOMES, LLC
Active
Other names
Kiononia Group Home Services, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA L FOREMAN (DIRECTOR)
(252) 266-5496
Entity
Organization
Contact information
Practice address
507 TOBACCO RD, ROCKY MOUNT, NC 27801-6936
(252) 266-5496
Mailing address
1444 JEFFREYS ROAD, PMB 273, ROCKY MOUNT, NC 27804
(252) 266-5496
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
NULL
253J00000X
Foster Care Agency
—
NULL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
0000000000
NC
Other
Enumeration date
09/19/2012
Last updated
09/19/2012
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