Provider Demographics
NPI:1558622969
Name:MYOVERREESE FELLOWSHIP HOMES INC
Entity Type:Organization
Organization Name:MYOVERREESE FELLOWSHIP HOMES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-779-1306
Mailing Address - Street 1:560 WILKES RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-3038
Mailing Address - Country:US
Mailing Address - Phone:910-779-1306
Mailing Address - Fax:910-486-5976
Practice Address - Street 1:560 WILKES RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-3038
Practice Address - Country:US
Practice Address - Phone:910-779-1306
Practice Address - Fax:910-486-5976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty