Organization
E & T ALLIANCE LLC
Active
Other names
A Healthy Haven
Organization subpart
No
Provider details
NPI number
Authorized official
MARK ELLERMEIER (PRESIDENT)
(919) 734-9956
Entity
Organization
Contact information
Practice address
410 MARCIA DR, GOLDSBORO, NC 27530-9213
(919) 734-9956
Mailing address
410 MARCIA DR, GOLDSBORO, NC 27530-9213
(919) 734-9956
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-096178
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603996
—
NC
Enumeration date
11/13/2006
Last updated
03/06/2009
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