Provider Demographics
NPI:1508139213
Name:OPEN HEARTS
Entity Type:Organization
Organization Name:OPEN HEARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:TELFAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-641-4005
Mailing Address - Street 1:509 BEASLEY ST
Mailing Address - Street 2:
Mailing Address - City:PRINCEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27886-5414
Mailing Address - Country:US
Mailing Address - Phone:252-641-4005
Mailing Address - Fax:252-641-4005
Practice Address - Street 1:509 BEASLEY ST
Practice Address - Street 2:
Practice Address - City:PRINCEVILLE
Practice Address - State:NC
Practice Address - Zip Code:27886-5414
Practice Address - Country:US
Practice Address - Phone:252-641-4005
Practice Address - Fax:252-641-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL033107320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities