Provider Demographics
NPI:1205000585
Name:WOODED ACRES GUEST HOME INC
Entity Type:Organization
Organization Name:WOODED ACRES GUEST HOME INC
Other - Org Name:THE OAK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-946-2324
Mailing Address - Street 1:3622 CHERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-7268
Mailing Address - Country:US
Mailing Address - Phone:252-946-7325
Mailing Address - Fax:
Practice Address - Street 1:3622 CHERRY ROAD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-7268
Practice Address - Country:US
Practice Address - Phone:252-946-7325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X
NCMHL-007-067261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health