34D2076755 CLIA NUMBER - EMMANUEL HOME LLC, THE

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Laboratory Demographics

CLIA Number: 34D2076755

Facility Name: EMMANUEL HOME LLC, THE

Facility Address:
5212 SWEETBRIAR DRIVE
RALEIGH, NC
ZIP 27609
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Facility Phone Number: 919 231-2981

Facility Type: Other - GROUP HOME

Certificate Type: Waiver

NPI Number: 1639213846

Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.

CLIA Record

Field Name	Field Value
CLIA Number	34D2076755
LAB Type	Other - GROUP HOME
Facility Name	EMMANUEL HOME LLC, THE
Street	5212 SWEETBRIAR DRIVE
City	RALEIGH
State	NC
ZIP	27609
Phone	919 231-2981
CertificateType	4
CertificateEffectiveDate	4/25/2022
CertificateExpirationDate	4/24/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024