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General NPI Number Information
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NPI Number | 1629254719
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Entity Type | Organization
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Legal Business Name | CIDDS FOUNDATION OF NC
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 6863 WINCHESTER ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-5634
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Country | US
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Telephone | 910-366-7005
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Fax |
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Provider Business Mailing Address
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Address Line | 6863 WINCHESTER ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-5634
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Country | US
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Telephone | 910-366-7005
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. TERESA JANE NAPPER
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Credential |
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Telephone | 910-366-7005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | 3409527
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License Number State | NC
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