Provider Demographics
NPI:1275620296
Name:UNIVERSITY OF NC @ CHAPEL HILL
Entity Type:Organization
Organization Name:UNIVERSITY OF NC @ CHAPEL HILL
Other - Org Name:TEACCH DIVISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACT-VICE CHANCELLOR BUSINESS AFFAIR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:919-962-3798
Mailing Address - Street 1:302A S BUILDING CB # 1000
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-1000
Mailing Address - Country:US
Mailing Address - Phone:919-962-3798
Mailing Address - Fax:919-962-0647
Practice Address - Street 1:100 RENEE LYNNE CT CB # 7180
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7180
Practice Address - Country:US
Practice Address - Phone:919-843-1677
Practice Address - Fax:919-966-4127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3408563251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408563Medicaid