Provider Demographics
NPI:1124396056
Name:HEALTHY LIVING GROUP SERVICES, INC.
Entity Type:Organization
Organization Name:HEALTHY LIVING GROUP SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLAMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-641-0000
Mailing Address - Street 1:805 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-2735
Mailing Address - Country:US
Mailing Address - Phone:910-641-0000
Mailing Address - Fax:910-641-0001
Practice Address - Street 1:805 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-2735
Practice Address - Country:US
Practice Address - Phone:910-641-0000
Practice Address - Fax:910-641-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320800000X
NC01980332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies