Provider Demographics
NPI:1235395294
Name:HOUSEOFPROSPERITY
Entity Type:Organization
Organization Name:HOUSEOFPROSPERITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:RAYNETTE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-253-3764
Mailing Address - Street 1:1805 N BERKELEY BLVD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-3307
Mailing Address - Country:US
Mailing Address - Phone:919-288-1608
Mailing Address - Fax:919-288-2108
Practice Address - Street 1:118 ELLIS DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9500
Practice Address - Country:US
Practice Address - Phone:980-253-3764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSEOFPROSPERITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-096-199320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness