Provider Demographics
NPI:1194858761
Name:MEREDITH COLLEGE
Entity Type:Organization
Organization Name:MEREDITH COLLEGE
Other - Org Name:MEREDITH AUTISM PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-760-8511
Mailing Address - Street 1:3800 HILLSBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-5237
Mailing Address - Country:US
Mailing Address - Phone:919-760-8249
Mailing Address - Fax:919-760-8818
Practice Address - Street 1:3800 HILLSBOROUGH ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5237
Practice Address - Country:US
Practice Address - Phone:919-760-8249
Practice Address - Fax:919-760-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL092-526174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408887Medicaid