Provider Demographics
NPI:1508900457
Name:SIXTH STREET DDA GROUP HOME
Entity Type:Organization
Organization Name:SIXTH STREET DDA GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:TORAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-222-1812
Mailing Address - Street 1:313 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5732
Mailing Address - Country:US
Mailing Address - Phone:336-222-1812
Mailing Address - Fax:
Practice Address - Street 1:313 E 6TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5732
Practice Address - Country:US
Practice Address - Phone:336-222-1812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCDDL001024261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804366Medicaid