Organization
HEAVENLYGATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARSHA VIOLET HOWARD L.P.N. (DIRECTOR)
(336) 254-3137
Entity
Organization
Contact information
Practice address
1407 DUNBAR ST, GREENSBORO, NC 27401-3801
(336) 617-3036
(336) 617-3036
Mailing address
1407 DUNBAR ST, GREENSBORO, NC 27401-3801
(336) 617-3036
(336) 617-3036
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL-041-882
NC
Other
Enumeration date
12/11/2008
Last updated
12/11/2008
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