1386791796 NPI number — J IVERSON RIDDLE DEVELOPMENTAL CENTER

Table of content: (NPI 1386791796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386791796 NPI number — J IVERSON RIDDLE DEVELOPMENTAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J IVERSON RIDDLE DEVELOPMENTAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAMILY, INFANT AND PRESCHOOL PROGRAM
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386791796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 ENOLA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28655-4608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-433-2661
Provider Business Mailing Address Fax Number:
828-438-6457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 ENOLA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28655-4608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-433-2661
Provider Business Practice Location Address Fax Number:
828-438-6457
Provider Enumeration Date:
01/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROBARGE
Authorized Official First Name:
ARTHUR
Authorized Official Middle Name:
J
Authorized Official Title or Position:
FACILITY DIRECTOR
Authorized Official Telephone Number:
828-433-2711

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8300103 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com