Provider Demographics
NPI:1639313430
Name:RAPHA HOUSE/RAPHA 4 KIDZ
Entity type:Organization
Organization Name:RAPHA HOUSE/RAPHA 4 KIDZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALTHEA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:DUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP
Authorized Official - Phone:704-898-2618
Mailing Address - Street 1:543 COX RD STE C8
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0607
Mailing Address - Country:US
Mailing Address - Phone:704-898-2618
Mailing Address - Fax:980-251-1470
Practice Address - Street 1:543 COX RD
Practice Address - Street 2:SUITE D-1
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054
Practice Address - Country:US
Practice Address - Phone:704-460-9214
Practice Address - Fax:704-865-1354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCODE 145OtherFOSTER CARE LICENSING AGENCY