Organization
HILLS DDA GROUP HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALICETINE P ROUSE (ADMINISTRATOR)
(252) 522-4869
Entity
Organization
Contact information
Practice address
2017 EAST RIDGE CIR, KINSTON, NC 28501
(252) 522-4869
Mailing address
PO BOX 5425, 2017 EAST RIDGE CIRCLE, KINSTON, NC 28501
(252) 522-4869
(252) 522-4869
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
MHL054111
NC
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805117
—
NC
01
—
MHL054111
LICENSE #
NC
Enumeration date
12/20/2007
Last updated
07/21/2008
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