Provider Demographics
NPI:1366649394
Name:CRAVEN CHERRY POINT CHILD DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:CRAVEN CHERRY POINT CHILD DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:252-447-3892
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:200 WEBB BLVD.
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-0629
Mailing Address - Country:US
Mailing Address - Phone:252-447-3892
Mailing Address - Fax:252-447-2004
Practice Address - Street 1:200 WEBB BLVD
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-1930
Practice Address - Country:US
Practice Address - Phone:252-447-3892
Practice Address - Fax:252-447-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7210875225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210875Medicaid