=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386744589
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRIANGLE PARK VOCATIONAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 PHEASANT WOOD CT #300
-----------------------------------------------------
City | MORRISVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27560-7087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-468-5030
-----------------------------------------------------
Fax | 919-462-8733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 PHEASANT WOOD CT #300
-----------------------------------------------------
City | MORRISVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27560-7087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-468-5030
-----------------------------------------------------
Fax | 919-462-8733
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | INNA DENG JOHNSON
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 919-468-5030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------