Organization
ILLUMI-NATION CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY ELIZABETH HYMAN CNA, MT (OWNER)
(252) 641-0020
Entity
Organization
Contact information
Practice address
7806 HWY 42 EAST, TARBORO, NC 27886
(252) 641-0020
Mailing address
7806 HWY 42 EAST, TARBORO, NC 27886
(252) 641-0020
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL-033-114
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
MHL-033-114
NC
Other
Enumeration date
04/19/2011
Last updated
08/29/2012
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