Provider Demographics
NPI:1982735239
Name:THE JANICE MAE HAWKINS FOUNDATION, INC.
Entity Type:Organization
Organization Name:THE JANICE MAE HAWKINS FOUNDATION, INC.
Other - Org Name:S & S SPOONRIDGE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO ADMINISTRATOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, SANE, CLNC,
Authorized Official - Phone:910-864-3426
Mailing Address - Street 1:3359 GABLES DR.
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-0340
Mailing Address - Country:US
Mailing Address - Phone:910-864-3426
Mailing Address - Fax:910-491-6803
Practice Address - Street 1:3359 GABLES DR.
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301
Practice Address - Country:US
Practice Address - Phone:910-864-3426
Practice Address - Fax:910-764-1457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-026-809251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409680Medicaid