Healthcare Provider Details

I. General information

NPI: 1538387923
Provider Name (Legal Business Name): J. IVERSON RIDDLE DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ENOLA RD
MORGANTON NC
28655
US

IV. Provider business mailing address

300 ENOLA RD
MORGANTON NC
28655-4608
US

V. Phone/Fax

Practice location:
  • Phone: 828-433-2722
  • Fax: 828-433-2724
Mailing address:
  • Phone: 828-433-2722
  • Fax: 828-433-2724

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
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KAREN BURKES
Title or Position: DIVISION DIRECTOR - DSOHF
Credential:
Phone: 919-855-4700