Organization
ROSE PALMS LIGHT OF HOPE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BROOKS (EX. DIRECTOR)
(980) 822-4195
Entity
Organization
Contact information
Practice address
8116 S TRYON ST, STE B3,BOX123, CHARLOTTE, NC 28273-4300
(980) 522-4195
(888) 854-8514
Mailing address
8116 S TRYON ST, STE B3,BOX123, CHARLOTTE, NC 28273-4300
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/26/2015
Last updated
11/26/2015
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