Provider Demographics
NPI:1699811125
Name:MURDOCH DEVELOPMENTAL CENTER
Entity Type:Organization
Organization Name:MURDOCH DEVELOPMENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLSTENHOLME
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-855-4700
Mailing Address - Street 1:PO BOX 3000
Mailing Address - Street 2:1600 EAST C STREET
Mailing Address - City:BUTNER
Mailing Address - State:NC
Mailing Address - Zip Code:27509-2530
Mailing Address - Country:US
Mailing Address - Phone:919-575-1000
Mailing Address - Fax:919-575-1104
Practice Address - Street 1:1600 EAST C STREET
Practice Address - Street 2:
Practice Address - City:BUTNER
Practice Address - State:NC
Practice Address - Zip Code:27509-2530
Practice Address - Country:US
Practice Address - Phone:919-575-1000
Practice Address - Fax:919-575-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406025Medicaid