Healthcare Provider Details

I. General information

NPI: 1932531720
Provider Name (Legal Business Name): PHP OF NC,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PONY RD STE B
ZEBULON NC
27597-2656
US

IV. Provider business mailing address

700 PONY RD STE B
ZEBULON NC
27597-2656
US

V. Phone/Fax

Practice location:
  • Phone: 919-375-4702
  • Fax: 919-375-4838
Mailing address:
  • Phone: 919-375-4702
  • Fax: 919-375-4838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. JUSTINE WIGGINS
Title or Position: CEO
Credential:
Phone: 919-220-0021