Organization
SUPPORTIVE SPACES ADULT CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DESHON WISE (DIRECTOR)
(919) 671-1989
Entity
Organization
Contact information
Practice address
116 MORGAN DR, ZEBULON, NC 27597-5959
(919) 671-1989
Mailing address
1513 PARKS VILLAGE RD, ZEBULON, NC 27597-9580
(919) 671-1989
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
311ZA0620X
Adult Care Home Facility
—
—
Other
Enumeration date
07/16/2024
Last updated
07/17/2024
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