Provider Demographics
NPI:1649073065
Name:OLIVER'S HOUSE LLC
Entity type:Organization
Organization Name:OLIVER'S HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ORGANIZER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:D
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-512-9568
Mailing Address - Street 1:3306 DORAL CT
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8101
Mailing Address - Country:US
Mailing Address - Phone:336-512-9568
Mailing Address - Fax:
Practice Address - Street 1:604 LEE ST
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9155
Practice Address - Country:US
Practice Address - Phone:336-512-9568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities