Organization
PHOENIX HOMES #2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LOTANNA OMEZE NWANKWO (DIRECTOR/ADMINISTRATOR)
(919) 522-9896
Entity
Organization
Contact information
Practice address
5628 MILLRACE TRL, RALEIGH, NC 27606-9227
(919) 522-9896
(919) 231-1456
Mailing address
5628 MILLRACE TRL, RALEIGH, NC 27606-9227
(919) 522-9896
(919) 231-1456
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-092-741
NC
Other
Enumeration date
05/06/2009
Last updated
05/06/2009
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