Provider Demographics
NPI:1548402985
Name:TRADING PLACES ENRICHMENT CENTER
Entity Type:Organization
Organization Name:TRADING PLACES ENRICHMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ECECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:BS
Authorized Official - Phone:252-367-0918
Mailing Address - Street 1:216 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-2354
Mailing Address - Country:US
Mailing Address - Phone:252-792-2301
Mailing Address - Fax:252-661-4578
Practice Address - Street 1:216 WILSON ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2354
Practice Address - Country:US
Practice Address - Phone:252-792-2301
Practice Address - Fax:252-661-4578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC058031251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6604298Medicaid
NC6604148Medicaid