Organization
BO'S JOHNATHAN HOUSE, INC.
Active
Organization
BO'S JOHNATHAN HOUSE, INC.
Active
Parent organization
BO'S JOHNATHAN HOUSE, INC.
Other names
Bo's Johnathan House Adult Care, Inc.
Organization subpart
Yes
Provider details
NPI number
Legal business name
BO'S JOHNATHAN HOUSE, INC.
Authorized official
MRS. OBELIA WATSON HOCUTT (EXECUTIVE DIRECTOR)
(919) 369-5394
Entity
Organization
Contact information
Practice address
300 WILL RD, MIDDLESEX, NC 27557-8317
(919) 369-5394
Mailing address
12749 BUCK RD, MIDDLESEX, NC 27557-8308
(919) 269-7502
(919) 269-7502
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-051-168
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL-051-168
NC
Other
Enumeration date
11/25/2008
Last updated
01/27/2009
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