Provider Demographics
NPI:1326228099
Name:SOUTHRIDGE LEARNING CENTER INC
Entity Type:Organization
Organization Name:SOUTHRIDGE LEARNING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:MCCOMBS
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:252-756-5988
Mailing Address - Street 1:241 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5029
Mailing Address - Country:US
Mailing Address - Phone:252-756-5988
Mailing Address - Fax:252-756-9516
Practice Address - Street 1:241 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5029
Practice Address - Country:US
Practice Address - Phone:252-756-5988
Practice Address - Fax:252-756-9516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2414251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health