Provider Demographics
NPI:1477684116
Name:BEAUFORT COUNTY DEVELOPMENTAL CENTER, INC
Entity Type:Organization
Organization Name:BEAUFORT COUNTY DEVELOPMENTAL CENTER, INC
Other - Org Name:BEAUFORT COUNTY GROUP HOME #2
Other - Org Type:Doing Business As
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:P.O. BOX 518
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:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-007-027311ZA0620X, 320600000X
NCMHL007027320600000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804359Medicaid