Healthcare Provider Details

I. General information

NPI: 1518153683
Provider Name (Legal Business Name): MICHAEL'S PLACE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 10/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 CASCADILLA ST
DURHAM NC
27704-4411
US

IV. Provider business mailing address

2815 CASCADILLA ST
DURHAM NC
27704-4411
US

V. Phone/Fax

Practice location:
  • Phone: 919-957-7985
  • Fax: 919-957-7985
Mailing address:
  • Phone: 919-957-7985
  • Fax: 919-957-7985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMHL-032-415
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberMHL-032-415
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL-032-415
License Number StateNC

VIII. Authorized Official

Name: MRS. ALVETH JOYCE YOUNG
Title or Position: CO-OWNER
Credential: MD
Phone: 919-957-7985