Healthcare Provider Details

I. General information

NPI: 1831131275
Provider Name (Legal Business Name): BEAUFORT COUNTY DEVELOPMENTAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 W 5TH ST
WASHINGTON NC
27889-4108
US

IV. Provider business mailing address

P.O. BOX 518
WASHINGTON NC
27889-4108
US

V. Phone/Fax

Practice location:
  • Phone: 252-946-0151
  • Fax: 252-946-9783
Mailing address:
  • Phone: 252-946-0151
  • Fax: 252-946-9783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number07000014
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number07000014
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number07000014
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number07000014
License Number StateNC

VIII. Authorized Official

Name: MRS. ELENA GILMORE CAMERON
Title or Position: COO
Credential:
Phone: 252-946-0151