Organization · Type 2 NPI

Bo's Johnathan House, Inc.

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Middlesex, NC

NPI number 1194970681 Active

Practice location

300 Will Rd
Middlesex, NC 27557-8317

Call (919) 369-5394 Map

Mailing address

12749 Buck Rd
Middlesex, NC 27557-8308

Specialties and licenses

Taxonomy	Code	License
Intellectual and/or Developmental Disabilities Residential Treatment Facility	320600000X	MHL-051-168 (NC)
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary	320900000X	MHL-051-168 (NC)

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.

3 other providers at this address

NPI record

NPI: 1194970681
Entity type: Organization (Type 2)
Issued: Nov 25, 2008
Last updated: Jan 27, 2009
Status: Active
Subpart: Yes of Bo's Johnathan House, Inc.

Other names

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Bo's Johnathan House Adult Care, Inc. · doing business as

Authorized official

Mrs. Obelia Watson Hocutt
Executive Director
(919) 369-5394

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1194970681

Bo's Johnathan House, Inc.'s National Provider Identifier is 1194970681, issued on Nov 25, 2008. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Middlesex, NC. The record was last updated on Jan 27, 2009.