Provider Demographics
NPI:1629254719
Name:CIDDS FOUNDATION OF NC
Entity Type:Organization
Organization Name:CIDDS FOUNDATION OF NC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:NAPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-366-7005
Mailing Address - Street 1:6863 WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5634
Mailing Address - Country:US
Mailing Address - Phone:910-366-7005
Mailing Address - Fax:
Practice Address - Street 1:6863 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-5634
Practice Address - Country:US
Practice Address - Phone:910-366-7005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3409527385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409527Medicaid