Organization
HOMELIFE GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BEN JOHNSON (DIRECTOR OF OPS)
(919) 450-5640
Entity
Organization
Contact information
Practice address
917 LANCASTER ST, DURHAM, NC 27701-1551
(919) 450-5640
Mailing address
917 LANCASTER ST, DURHAM, NC 27701-1551
(919) 450-5640
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL032544
NC
Other
Enumeration date
08/26/2010
Last updated
08/26/2010
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