Organization
PEACE HAVEN GROUP HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHRYN VOGLER JORDAN QMHP (OWNER/DIRECTOR)
(828) 632-0509
Entity
Organization
Contact information
Practice address
3122 VASHTI RD, TAYLORSVILLE, NC 28681-6828
(828) 632-0509
Mailing address
3122 VASHTI RD, TAYLORSVILLE, NC 28681-6828
(828) 632-0509
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-002-019
NC
Other
Enumeration date
03/16/2009
Last updated
03/16/2009
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