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General NPI Number Information
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NPI Number | 1851393177
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Entity Type | Organization
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Legal Business Name | PROGRAM RESOURCE INSTITUTE, INC.
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 404 W MAIN ST
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City | SANFORD
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State | NC
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Zip | 27332-5924
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Country | US
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Telephone | 919-774-1282
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Fax | 919-774-1283
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Provider Business Mailing Address
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Address Line | 108 N ORANGE AVE
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City | DUNN
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State | NC
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Zip | 28334-3826
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Country | US
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Telephone | 910-891-7062
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Fax | 910-892-3764
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. TED C. FITZGERALD
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Credential | M.S.
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Telephone | 910-891-7062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | 053-011
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License Number State | NC
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