Provider Demographics
NPI:1487429163
Name:HARMONY HOUSE OF MOORE COUNTY
Entity type:Organization
Organization Name:HARMONY HOUSE OF MOORE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:FAULK
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC-QS, LCAS, NCC
Authorized Official - Phone:910-691-5159
Mailing Address - Street 1:590 W DENNY AVE
Mailing Address - Street 2:
Mailing Address - City:PINEBLUFF
Mailing Address - State:NC
Mailing Address - Zip Code:28373-8337
Mailing Address - Country:US
Mailing Address - Phone:910-691-5159
Mailing Address - Fax:
Practice Address - Street 1:1180 W MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-4620
Practice Address - Country:US
Practice Address - Phone:910-691-5159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1801134614OtherOWNER'S NPI