Provider Demographics
NPI:1639213846
Name:THE EMMANUEL HOME III
Entity Type:Organization
Organization Name:THE EMMANUEL HOME III
Other - Org Name:E D EMMANUEL HOMES,LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHABRITTANY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOWTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-231-2981
Mailing Address - Street 1:PO BOX 26153
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27611-6153
Mailing Address - Country:US
Mailing Address - Phone:919-231-2981
Mailing Address - Fax:919-231-2982
Practice Address - Street 1:5212 SWEETBRIAR DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4544
Practice Address - Country:US
Practice Address - Phone:919-231-2981
Practice Address - Fax:919-231-2982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL092579320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805005Medicaid