Provider Demographics
NPI:1649595729
Name:MAKING A DIFFERENCE COMMUNITY SUPPORT INC
Entity Type:Organization
Organization Name:MAKING A DIFFERENCE COMMUNITY SUPPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DESIGNEE
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-793-2823
Mailing Address - Street 1:49 MACKEYS RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NC
Mailing Address - Zip Code:27962-9609
Mailing Address - Country:US
Mailing Address - Phone:252-793-2823
Mailing Address - Fax:252-793-4139
Practice Address - Street 1:104 W WATER ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-1306
Practice Address - Country:US
Practice Address - Phone:252-793-2823
Practice Address - Fax:252-793-4139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty