Organization
GARDEN OF LIFE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DESHALL HILL (OWNER)
(890) 309-6863
Entity
Organization
Contact information
Practice address
8339 FOX SWAMP RD, CHARLOTTE, NC 28215-9011
(980) 309-6863
Mailing address
8339 FOX SWAMP RD, CHARLOTTE, NC 28215-9011
(845) 728-9166
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1041I0000X
—
NC
05
—
106H0000X
—
NC
05
—
106S0000X
—
NC
05
—
164W0000X
—
NC
05
—
171M00000X
—
NC
05
—
175T0000X
—
NC
05
—
22420000X
—
NC
05
—
225I0000X
—
NC
05
—
2260000X
—
NC
05
—
251B00000X
—
NC
05
—
251S00000X
—
NC
05
—
302F0000X
—
NC
05
—
302R0000X
—
NC
05
—
305R0000X
—
NC
05
—
363L0000X
—
NC
Enumeration date
04/30/2020
Last updated
08/13/2020
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