Organization
UNIQUE HAVEN RESIDENTIAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALETHEA MARCELLUS BACHELOR PSYCHOLOGY (CLINICAL CONSULTANT)
(919) 306-1469
Entity
Organization
Contact information
Practice address
608 YOUNG ST, CREEDMOOR, NC 27522-8347
(919) 528-7439
Mailing address
PO BOX 713, CREEDMOOR, NC 27522-0713
(919) 528-7439
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-039-043
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805713
—
NC
Enumeration date
01/07/2007
Last updated
08/16/2007
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