Provider Demographics
NPI:1801928395
Name:NAOMI'S GROUP HOMES
Entity type:Organization
Organization Name:NAOMI'S GROUP HOMES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-822-4736
Mailing Address - Street 1:PO BOX 478
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28302-0478
Mailing Address - Country:US
Mailing Address - Phone:910-424-6071
Mailing Address - Fax:
Practice Address - Street 1:1836 CONOVER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4562
Practice Address - Country:US
Practice Address - Phone:910-424-6071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 026 652320600000X
NCMHL 026 649320600000X
NCMHL 026 664320600000X
NCMHL 026 651320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities