Provider Demographics
NPI:1467892661
Name:DORETHA COMMUNITY DEVELOPMENT
Entity Type:Organization
Organization Name:DORETHA COMMUNITY DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CURTESE
Authorized Official - Middle Name:RENATA
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-802-0728
Mailing Address - Street 1:3313 BROOKLINE CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-8498
Mailing Address - Country:US
Mailing Address - Phone:252-802-0728
Mailing Address - Fax:
Practice Address - Street 1:3313 BROOKLINE CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8498
Practice Address - Country:US
Practice Address - Phone:252-802-0728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children