Provider Demographics
NPI:1407051287
Name:PRIODIGAL ALTERNATIVE CENTER INC
Entity Type:Organization
Organization Name:PRIODIGAL ALTERNATIVE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:QUICKBARKER
Authorized Official - Suffix:
Authorized Official - Credentials:CONSULTANT
Authorized Official - Phone:910-822-0235
Mailing Address - Street 1:6102 MCDOUGAL DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2420
Mailing Address - Country:US
Mailing Address - Phone:910-822-0235
Mailing Address - Fax:
Practice Address - Street 1:6102 MCDOUGAL DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2420
Practice Address - Country:US
Practice Address - Phone:910-822-0235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health