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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
SHANTA HARRELL (OWNER)
(252) 642-3851
Entity
Organization

Contact information

Practice address
106 HOLLOMAN AVE E, AHOSKIE, NC 27910-2307
(252) 642-3851
Mailing address
1219 CATHERINE ST N, AHOSKIE, NC 27910-2303
(252) 642-3851

Taxonomy

Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
FCI046025
NC

Other

Enumeration date
10/26/2016
Last updated
10/26/2016
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