Provider Demographics
NPI:1770603920
Name:SAVANNAH HOUSE OF LOVE GROUP HOME
Entity type:Organization
Organization Name:SAVANNAH HOUSE OF LOVE GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-430-0084
Mailing Address - Street 1:334 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-3639
Mailing Address - Country:US
Mailing Address - Phone:252-430-0084
Mailing Address - Fax:252-430-7732
Practice Address - Street 1:334 PEARL ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-3639
Practice Address - Country:US
Practice Address - Phone:252-430-0084
Practice Address - Fax:252-430-7732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-091-078320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities