Healthcare Provider Details

I. General information

NPI: 1811344708
Provider Name (Legal Business Name): BUBBLES OF FUN DEVELOPMENTAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 EAGLE RD
BENSON NC
27504-7256
US

IV. Provider business mailing address

1122 PACKING PLANT RD
SMITHFIELD NC
27577-7894
US

V. Phone/Fax

Practice location:
  • Phone: 919-538-0423
  • Fax: 919-400-4611
Mailing address:
  • Phone: 919-538-0423
  • Fax: 919-400-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JOSELIN RUIZ
Title or Position: CO-OWNER
Credential:
Phone: 919-538-0423