Organization
R&SYOUTHHAVENLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN WASHINGTON (OWNER)
(704) 516-7190
Entity
Organization
Contact information
Practice address
1172 HUNTSMOOR DR, GASTONIA, NC 28054-7205
(704) 516-7190
Mailing address
1172 HUNTSMOOR DR, GASTONIA, NC 28054-7205
(704) 516-7190
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/03/2022
Last updated
08/03/2022
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