Provider Demographics
NPI:1225207491
Name:RESOURCES FOR HUMAN DEVELOPMENT, INC.
Entity Type:Organization
Organization Name:RESOURCES FOR HUMAN DEVELOPMENT, INC.
Other - Org Name:DURHAM AREA ADOLESCENT PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-894-9925
Mailing Address - Street 1:811 UNDERWOOD AVE
Mailing Address - Street 2:APT. C-9
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-2988
Mailing Address - Country:US
Mailing Address - Phone:919-489-8717
Mailing Address - Fax:919-489-8904
Practice Address - Street 1:947 CLARION DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-1730
Practice Address - Country:US
Practice Address - Phone:919-489-8717
Practice Address - Fax:919-489-8904
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESOURCES FOR HUMAN DEVELOPMENT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 032413320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301364Medicaid