Organization
THE LOVING HOME #3
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DESMOND OKORIEOCHA MBA (PRESIDENT/CEO)
(910) 624-0844
Entity
Organization
Contact information
Practice address
4944 MACEDONIA CHURCH RD, FAYETTEVILLE, NC 28312-5896
(910) 485-4742
(910) 484-0629
Mailing address
3608 THORNDIKE DR, FAYETTEVILLE, NC 28311-0309
(910) 488-4089
(910) 484-0629
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-026-882
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408341
—
NC
Enumeration date
08/06/2013
Last updated
08/06/2013
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