Provider Demographics
NPI:1699460618
Name:OLIVER HAYWOOD FAMILY HOME LLC
Entity type:Organization
Organization Name:OLIVER HAYWOOD FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-349-2473
Mailing Address - Street 1:254 GROVEMERE LN
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-9741
Mailing Address - Country:US
Mailing Address - Phone:919-349-2473
Mailing Address - Fax:
Practice Address - Street 1:254 GROVEMERE LN
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591-9741
Practice Address - Country:US
Practice Address - Phone:919-349-2473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health