Organization
OUR HOME IS YOUR HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VIOLA BEATRICE JACKSON LPN (CEO/PRESIDENT)
(252) 338-3284
Entity
Organization
Contact information
Practice address
206 W BROAD ST, ELIZABETH CITY, NC 27909-3521
(252) 338-3284
Mailing address
206 W BROAD ST, ELIZABETH CITY, NC 27909-3521
(252) 338-3284
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/12/2009
Last updated
08/12/2009
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