Provider Demographics
NPI:1518153683
Name:MICHAEL'S PLACE INC.
Entity Type:Organization
Organization Name:MICHAEL'S PLACE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALVETH
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-957-7985
Mailing Address - Street 1:2815 CASCADILLA ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4411
Mailing Address - Country:US
Mailing Address - Phone:919-957-7985
Mailing Address - Fax:919-957-7985
Practice Address - Street 1:2815 CASCADILLA ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-4411
Practice Address - Country:US
Practice Address - Phone:919-957-7985
Practice Address - Fax:919-957-7985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
315P00000X
NCMHL-032-415320800000X, 320900000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006190Medicaid