Provider Demographics
NPI:1790926137
Name:AMANI RESIDENTIAL HUMAN SERVICES
Entity Type:Organization
Organization Name:AMANI RESIDENTIAL HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFEREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, QP
Authorized Official - Phone:252-799-0600
Mailing Address - Street 1:312 WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-2146
Mailing Address - Country:US
Mailing Address - Phone:252-799-0600
Mailing Address - Fax:252-799-0644
Practice Address - Street 1:312 WEST BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2146
Practice Address - Country:US
Practice Address - Phone:252-799-0600
Practice Address - Fax:252-799-0644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-058-022251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health