Provider Demographics
NPI:1689774861
Name:PROGRAM RESOURCE INSTITUTE, INC.
Entity Type:Organization
Organization Name:PROGRAM RESOURCE INSTITUTE, INC.
Other - Org Name:BETHESDA LINK ADOLESCENT PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:910-891-7062
Mailing Address - Street 1:108 N ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-3826
Mailing Address - Country:US
Mailing Address - Phone:910-891-7062
Mailing Address - Fax:910-892-3764
Practice Address - Street 1:206 N PINE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2732
Practice Address - Country:US
Practice Address - Phone:910-944-2189
Practice Address - Fax:910-944-7443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC - 2870101YA0400X
NCMHL-076-0823245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Not Answered3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301451Medicaid