1437590106 NPI number — UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL-TEACCH AUTISM PROGRAM

Table of content: (NPI 1437590106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437590106 NPI number — UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL-TEACCH AUTISM PROGRAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL-TEACCH AUTISM PROGRAM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437590106
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 RENEE LYNN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARRBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27510-6511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-966-2173
Provider Business Mailing Address Fax Number:
919-966-4127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 REVOLUTION MILL DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-334-5773
Provider Business Practice Location Address Fax Number:
336-334-5811
Provider Enumeration Date:
07/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KELLY
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
BUSINESS OFFICER
Authorized Official Telephone Number:
919-966-6636

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  3408563 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3408563 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com