MEDICARE: THE ENRICHMENT CENTER-AN AFFILIATED CHAPTER OF THE ARC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	MHL-034-047	NC
2	251S00000X	Community/Behavioral Health Agency	MHL-034-047	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023133709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ENRICHMENT CENTER-AN AFFILIATED CHAPTER OF THE ARC

Provider Business Mailing Address
First Line	:	1006 S MARSHALL ST
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27101-5815
Country	:	US
Telephone Number	:	336-777-0076
Fax Number	:	336-777-0520

Provider Business Practice Location Address
First Line	:	1006 S MARSHALL ST
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27101
Country	:	US
Telephone Number	:	336-777-0076
Fax Number	:	336-777-0520

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	JULIE WOOD
Credential	:
Telephone Number	:	336-837-6824

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	06/05/2018

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