Organization
OPEN HEARTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBBIE DICKENS TELFAIR (OWNER)
(252) 641-0361
Entity
Organization
Contact information
Practice address
1400 W MOUNT DR, ROCKY MOUNT, NC 27803-3107
(252) 443-7391
(252) 443-7391
Mailing address
1400 W MOUNT DR, ROCKY MOUNT, NC 27803-3107
(252) 443-7391
(252) 443-7391
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL064110
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MHL064110
NC STATE LOCENCE
NC
Enumeration date
01/26/2010
Last updated
01/26/2010
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