Organization
LANE'S HOUSE ADULT GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LILLIE B LANE (LICENSEE)
(252) 903-4660
Entity
Organization
Contact information
Practice address
3159 OCTAVIA DR, ROCKY MOUNT, NC 27804-7959
(252) 903-4660
Mailing address
3159 OCTAVIA DR, ROCKY MOUNT, NC 27804-7959
(252) 903-4660
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
MHL-064-126
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MHL-064-126
MENTAL HEALTH LICENSE NUMBER
NC
Enumeration date
11/07/2011
Last updated
12/08/2011
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