Provider Demographics
NPI:1609051382
Name:HAPPY HOMES OF NORTH CAROLINA
Entity Type:Organization
Organization Name:HAPPY HOMES OF NORTH CAROLINA
Other - Org Name:'OUR PLACE '
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:POLAVARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-559-6141
Mailing Address - Street 1:907 KILDAIRE FARM RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-3922
Mailing Address - Country:US
Mailing Address - Phone:919-559-6141
Mailing Address - Fax:919-319-6365
Practice Address - Street 1:1040 BUCK JONES RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3323
Practice Address - Country:US
Practice Address - Phone:919-559-6141
Practice Address - Fax:919-319-6365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-092-694251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services