Provider Demographics
NPI:1871772731
Name:AMANDLA ENTERPRISES INC.
Entity type:Organization
Organization Name:AMANDLA ENTERPRISES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HAMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-243-4111
Mailing Address - Street 1:111 NASH ST W # 204
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4012
Mailing Address - Country:US
Mailing Address - Phone:252-234-4111
Mailing Address - Fax:252-234-4111
Practice Address - Street 1:111 NASH ST W # 204
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4012
Practice Address - Country:US
Practice Address - Phone:252-234-4111
Practice Address - Fax:252-234-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities