Provider Demographics
NPI:1114203759
Name:THE EMMANUEL HOME
Entity Type:Organization
Organization Name:THE EMMANUEL HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELOISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOWTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-231-2981
Mailing Address - Street 1:PO BOX 26153
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27611-6153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5901 S SHARON DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-4665
Practice Address - Country:US
Practice Address - Phone:919-231-2981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-092-528320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities