Provider Demographics
NPI:1275684664
Name:HAWTHORNE SERVICES INCORPORATED
Entity Type:Organization
Organization Name:HAWTHORNE SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINITRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:LUCINDA
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-735-2158
Mailing Address - Street 1:1912 STEPHENS ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-6756
Mailing Address - Country:US
Mailing Address - Phone:919-735-2158
Mailing Address - Fax:919-288-3644
Practice Address - Street 1:1510 S SLOCUMB ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-6955
Practice Address - Country:US
Practice Address - Phone:919-735-2158
Practice Address - Fax:919-288-3644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL096148320600000X
NCMHL096119320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804703Medicaid
NC8301062BMedicaid
NC3408681Medicaid