Provider Demographics
NPI:1699937797
Name:HEROS HOUSE OF ROYAL DREAMS
Entity type:Organization
Organization Name:HEROS HOUSE OF ROYAL DREAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:ANTOINE
Authorized Official - Last Name:RAYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-480-8612
Mailing Address - Street 1:2701 GARCES CIR
Mailing Address - Street 2:
Mailing Address - City:PFAFFTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27040-9470
Mailing Address - Country:US
Mailing Address - Phone:336-924-0840
Mailing Address - Fax:
Practice Address - Street 1:2701 GARCES CIR
Practice Address - Street 2:
Practice Address - City:PFAFFTOWN
Practice Address - State:NC
Practice Address - Zip Code:27040-9470
Practice Address - Country:US
Practice Address - Phone:336-924-0840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children