Provider Demographics
NPI:1659084721
Name:DONTAES HOUSE, LLC
Entity Type:Organization
Organization Name:DONTAES HOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ALBERTA
Authorized Official - Last Name:BLAKELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-531-7725
Mailing Address - Street 1:367 BRANCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-8693
Mailing Address - Country:US
Mailing Address - Phone:252-531-7725
Mailing Address - Fax:
Practice Address - Street 1:367 BRANCHWOOD DR
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-8693
Practice Address - Country:US
Practice Address - Phone:252-531-7725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child