Provider Demographics
NPI:1417088279
Name:BEAUFORT COUNTY DEVELOPMENTAL CENTER, INC.
Entity Type:Organization
Organization Name:BEAUFORT COUNTY DEVELOPMENTAL CENTER, INC.
Other - Org Name:VOICE
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:GILMORE
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-946-0151
Mailing Address - Street 1:1534 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4108
Mailing Address - Country:US
Mailing Address - Phone:252-946-0151
Mailing Address - Fax:252-946-9783
Practice Address - Street 1:1534 W 5TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4108
Practice Address - Country:US
Practice Address - Phone:252-946-0151
Practice Address - Fax:252-946-9783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL007002251C00000X, 251S00000X, 261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408370Medicaid