Provider Demographics
NPI:1548385040
Name:NEWPORT DEVELOPMENTAL CENTER
Entity Type:Organization
Organization Name:NEWPORT DEVELOPMENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OGLESBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-223-4574
Mailing Address - Street 1:903 CHURCH STREET
Mailing Address - Street 2:P.O. BOX 171
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-0171
Mailing Address - Country:US
Mailing Address - Phone:252-223-4574
Mailing Address - Fax:252-223-4920
Practice Address - Street 1:903 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-0171
Practice Address - Country:US
Practice Address - Phone:252-223-4574
Practice Address - Fax:252-223-4920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408198Medicaid