Provider Demographics
NPI:1063682573
Name:HERBERT WAY OF LIVING,LLC
Entity Type:Organization
Organization Name:HERBERT WAY OF LIVING,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-620-1416
Mailing Address - Street 1:3326 GUESS RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2160
Mailing Address - Country:US
Mailing Address - Phone:919-620-1416
Mailing Address - Fax:919-620-1456
Practice Address - Street 1:3014 FORRESTER ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2310
Practice Address - Country:US
Practice Address - Phone:919-220-5747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL032426320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities