Provider Demographics
NPI:1326284928
Name:HAWTHORN HOUSE
Entity Type:Organization
Organization Name:HAWTHORN HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-209-6986
Mailing Address - Street 1:1025 HWY 45 NORTH
Mailing Address - Street 2:
Mailing Address - City:MERRY HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27957
Mailing Address - Country:US
Mailing Address - Phone:252-356-4141
Mailing Address - Fax:
Practice Address - Street 1:1025 HWY 45 NORTH
Practice Address - Street 2:
Practice Address - City:MERRY HILL
Practice Address - State:NC
Practice Address - Zip Code:27957-9408
Practice Address - Country:US
Practice Address - Phone:252-356-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL 008-025311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFCL-008-025OtherFAMILY CARE LICENSE NUMBER