Provider Demographics
NPI:1972641447
Name:PHILIP HOUSETHERAPEUTIC SERVICES INC
Entity Type:Organization
Organization Name:PHILIP HOUSETHERAPEUTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSEMARY NJOKU
Authorized Official - Middle Name:ANAYO
Authorized Official - Last Name:NJOKU
Authorized Official - Suffix:
Authorized Official - Credentials:BA,
Authorized Official - Phone:919-395-5227
Mailing Address - Street 1:5801 CHERRYRAIN CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-5586
Mailing Address - Country:US
Mailing Address - Phone:919-676-5840
Mailing Address - Fax:919-676-5839
Practice Address - Street 1:5401 ORCHARD POND DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-6183
Practice Address - Country:US
Practice Address - Phone:919-862-1929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-04
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-092-644320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418243Medicaid
NC7805521Medicaid