Organization
HEAVENLY PLACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIET OKWOSHAH (ADMINISTRATOR)
(919) 819-3882
Entity
Organization
Contact information
Practice address
8600 NEUSE HUNTER DR, RALEIGH, NC 27616-7735
(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
MHL-092-866
NC
Other
Enumeration date
07/21/2013
Last updated
07/21/2013
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