Provider Demographics
NPI:1073786703
Name:REDEEM HOUSE, LLC
Entity Type:Organization
Organization Name:REDEEM HOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LONDON
Authorized Official - Middle Name:CORREL
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:864-607-8051
Mailing Address - Street 1:2729 GILLIAM RD
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244-9162
Mailing Address - Country:US
Mailing Address - Phone:864-607-8051
Mailing Address - Fax:
Practice Address - Street 1:2729 GILLIAM RD
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244-9162
Practice Address - Country:US
Practice Address - Phone:864-607-8051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-001-157322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children