Provider Demographics
NPI:1659432623
Name:AVERY ASSOCIATION FOR EXCEPTIONAL CITIZENS
Entity Type:Organization
Organization Name:AVERY ASSOCIATION FOR EXCEPTIONAL CITIZENS
Other - Org Name:YELLOW MOUNTAIN ENTERPRISES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-733-2944
Mailing Address - Street 1:255 ESTATOA ST.
Mailing Address - Street 2:PO BOX 548
Mailing Address - City:NEWLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28657-8829
Mailing Address - Country:US
Mailing Address - Phone:828-733-2944
Mailing Address - Fax:828-733-5251
Practice Address - Street 1:255 ESTATOA ST.
Practice Address - Street 2:
Practice Address - City:NEWLAND
Practice Address - State:NC
Practice Address - Zip Code:28657-8829
Practice Address - Country:US
Practice Address - Phone:828-733-2944
Practice Address - Fax:828-733-5251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL006001251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418236Medicaid