| Hills Dda Group Home Inc | |
|
2017 East Ridge Cir Kinston NC 28501 | |
| (252) 522-4869 | |
| Not Available |
| Full Name | Hills Dda Group Home Inc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 2017 East Ridge Cir, Kinston, North Carolina |
| Authorized Official Name and Position | Alicetine P Rouse (ADMINISTRATOR) |
| Authorized Official Contact | 2525224869 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hills Dda Group Home Inc Po Box 5425 2017 East Ridge Circle Kinston NC 28501 Ph: (252) 522-4869 | Hills Dda Group Home Inc 2017 East Ridge Cir Kinston NC 28501 Ph: (252) 522-4869 |
| NPI Number | 1053595546 |
|---|---|
| Provider Enumeration Date | 12/20/2007 |
| Last Update Date | 07/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053595546 | NPI | - | NPPES |
| 7805117 | Medicaid | NC | |
| MHL054111 | Other | NC | LICENSE # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | MHL054111 (North Carolina) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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