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Organization

HEAVENLY PLACE LLC II

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JULIET OKWOSHAH (ADMINISTRATION)
(919) 819-3882
Entity
Organization

Contact information

Practice address
2105 GRESHAM LAKE RD, RALEIGH, NC 27615-4204
(919) 819-3882
Mailing address
PO BOX 41153, RALEIGH, NC 27629-1153

Taxonomy

Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary

Other

Enumeration date
03/27/2013
Last updated
03/27/2013
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