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General NPI Number Information
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NPI Number | 1447778071
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Entity Type | Organization
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Legal Business Name | BAC DEVELOPMENTAL PROGRAM INC
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Dates
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Enumeration Date | 09/04/2017
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Last Update Date | 09/04/2017
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Provider Practice Location Address
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Address Line | 2203 COLISEUM BLVD
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City | GREENSBORO
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State | NC
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Zip | 27403
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Country | US
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Telephone | 336-323-0066
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Fax | 336-545-4473
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Provider Business Mailing Address
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Address Line | 4309 PENTON PL
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City | GREENSBORO
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State | NC
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Zip | 27455
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Country | US
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Telephone | 336-545-4473
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Fax |
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Authorized Official
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Title or Position | ASST DIRECTOR
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Name | WILLETTE CARRINTON
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Credential |
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Telephone | 336-545-4473
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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 |
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License Number State | NC
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