Provider Demographics
NPI:1497869127
Name:PROGRAM RESOURCE INSTITUTE, INC.
Entity Type:Organization
Organization Name:PROGRAM RESOURCE INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:910-891-7062
Mailing Address - Street 1:108 N ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-3826
Mailing Address - Country:US
Mailing Address - Phone:910-891-7062
Mailing Address - Fax:910-892-3764
Practice Address - Street 1:133 W. CORNELIUS HARNETT BLVD.
Practice Address - Street 2:SUITE B
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-7854
Practice Address - Country:US
Practice Address - Phone:910-814-0394
Practice Address - Fax:910-814-1426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-043-002101YA0400X, 251B00000X
NCMHL-047-099251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301413GMedicaid
NC8301413QMedicaid
NC8301413BMedicaid
NC8301413Medicaid