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General NPI Number Information
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NPI Number | 1316095052
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Entity Type | Organization
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Legal Business Name | ROANOKE DEVELOPMENTAL CENTER INC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 03/03/2011
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Provider Practice Location Address
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Address Line | 609 ADAMS ST
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City | PLYMOUTH
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State | NC
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Zip | 27962-1813
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Country | US
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Telephone | 252-793-5077
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Fax | 252-793-9144
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Provider Business Mailing Address
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Address Line | PO BOX 967
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City | PLYMOUTH
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State | NC
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Zip | 27962-0967
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Country | US
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Telephone | 252-793-5077
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Fax | 252-793-9144
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. ZEBEDEE TAYLOR
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Credential | MSW, PHD
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Telephone | 252-793-5077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | MHL-094-002
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License Number State | NC
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