Provider Demographics
NPI:1437590106
Name:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL-TEACCH AUTISM PROGRAM
Entity Type:Organization
Organization Name:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL-TEACCH AUTISM PROGRAM
Other - Org Name:GREENSBORO TEACCH AUTISM PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:W
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-966-6636
Mailing Address - Street 1:100 RENEE LYNN CT
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-6511
Mailing Address - Country:US
Mailing Address - Phone:919-966-2173
Mailing Address - Fax:919-966-4127
Practice Address - Street 1:925 REVOLUTION MILL DR.
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405
Practice Address - Country:US
Practice Address - Phone:336-334-5773
Practice Address - Fax:336-334-5811
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL-TEACCH AUTISM PROGRAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-10
Last Update Date:2013-09-26
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