Provider Demographics
NPI:1881839009
Name:HUMBLE SPIRIT FOUNDATION
Entity type:Organization
Organization Name:HUMBLE SPIRIT FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RETIRED PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:VIOLA
Authorized Official - Middle Name:VAUGHAN
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:252-356-4108
Mailing Address - Street 1:925 QUEBEC RD
Mailing Address - Street 2:
Mailing Address - City:COLERAIN
Mailing Address - State:NC
Mailing Address - Zip Code:27924-9224
Mailing Address - Country:US
Mailing Address - Phone:252-356-4108
Mailing Address - Fax:
Practice Address - Street 1:925 QUEBEC RD
Practice Address - Street 2:
Practice Address - City:COLERAIN
Practice Address - State:NC
Practice Address - Zip Code:27924-9224
Practice Address - Country:US
Practice Address - Phone:252-287-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children