Healthcare Provider Details

I. General information

NPI: 1235269267
Provider Name (Legal Business Name): BEAUFORT COUNTY DEVELOPMENTAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 02/17/2017
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 1534 WEST 5TH STREET
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 Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMHL007026
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL007026
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL007026
License Number StateNC

VIII. Authorized Official

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