Provider Demographics
NPI:1427760503
Name:PEACEHAVEN FARM INC.
Entity type:Organization
Organization Name:PEACEHAVEN FARM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HOUSING
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-449-9900
Mailing Address - Street 1:1458 NC HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:WHITSETT
Mailing Address - State:NC
Mailing Address - Zip Code:27377-9772
Mailing Address - Country:US
Mailing Address - Phone:336-449-9900
Mailing Address - Fax:
Practice Address - Street 1:1458 NC HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:WHITSETT
Practice Address - State:NC
Practice Address - Zip Code:27377-9772
Practice Address - Country:US
Practice Address - Phone:336-449-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite Care