Organization
THE LOVING HOME, INC. #4
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DESMOND OKORIEOCHA MBA (PRESIDENT/CEO)
(910) 624-0844
Entity
Organization
Contact information
Practice address
1710 SCAMPTON DR, FAYETTEVILLE, NC 28303-3742
(910) 488-5468
(910) 484-0629
Mailing address
4944 MACEDONIA CHURCH RD, FAYETTEVILLE, NC 28312-5896
(910) 485-4742
(910) 484-0629
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-026-884
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408341
—
NC
Enumeration date
07/30/2013
Last updated
07/30/2013
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