MEDICARE: NC DEPT OF HEALTH AND HUMAN SERVICE/DVRS

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	235Z00000X	Speech-Language Pathologist
2	251S00000X	Community/Behavioral Health Agency

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

General Provider Information

NPI Number	:	1427233972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NC DEPT OF HEALTH AND HUMAN SERVICE/DVRS

Provider Business Mailing Address
First Line	:	805 RUGGLES DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-2025
Country	:	US
Telephone Number	:	919-855-3544
Fax Number	:	919-715-1776

Provider Business Practice Location Address
First Line	:	3080 HAMMOND BUSINESS PL STE 101
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-3666
Country	:	US
Telephone Number	:	919-664-1244
Fax Number	:	919-715-1776

Authorized Official
Title or Position	:	DIRECTOR, NCATP
Name	:	TAMMY D KOGER
Credential	:
Telephone Number	:	919-855-3544

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	07/27/2021

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Directions to “NC DEPT OF HEALTH AND HUMAN SERVICE/DVRS ” Practice Location

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