Provider Demographics
NPI:1891127437
Name:NIXON HOUSE
Entity Type:Organization
Organization Name:NIXON HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-220-0021
Mailing Address - Street 1:1525 NIXON ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-4353
Mailing Address - Country:US
Mailing Address - Phone:919-220-0021
Mailing Address - Fax:
Practice Address - Street 1:1500 E CLUB BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-3404
Practice Address - Country:US
Practice Address - Phone:919-220-0021
Practice Address - Fax:919-220-0021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHP OF NC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 032245320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities