Organization
UNIQUE HAVEN RESIDENTIAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DERRICK DEVON DAVIS (STAFF COORDINATOR)
(919) 247-3276
Entity
Organization
Contact information
Practice address
106 W CHURCH ST STE A, CREEDMOOR, NC 27522-9765
(919) 247-3276
Mailing address
106 W CHURCH ST STE A, CREEDMOOR, NC 27522-9765
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
039043
NC
Other
Enumeration date
10/09/2007
Last updated
10/09/2007
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