Provider Demographics
NPI:1770629206
Name:MURDOCH DEVELOPMENTAL CENTER
Entity Type:Organization
Organization Name:MURDOCH DEVELOPMENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UTILIZATION MANAGEMENT COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:REESE-JOSEFSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-855-4761
Mailing Address - Street 1:1600 EAST C STREET
Mailing Address - Street 2:
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
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408339Medicaid