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General NPI Number Information
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NPI Number | 1376688259
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Entity Type | Organization
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Legal Business Name | BRUNSWICK COMMUNITY COLLEGE INTERAGENCY PROGRAM
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 50 COLLEGE ROAD
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City | SUPPLY
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State | NC
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Zip | 28462-0030
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Country | US
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Telephone | 910-755-7374
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Fax | 910-755-7493
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Provider Business Mailing Address
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Address Line | PO BOX 30
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City | SUPPLY
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State | NC
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Zip | 28462-0030
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | GREGORRY BLAND
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Credential |
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Telephone | 910-755-7374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | MHL-010-001
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License Number State | NC
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