Provider Demographics
NPI:1821194531
Name:DEVELOPMENTAL DISABILITIES RESOURCES, INC.
Entity Type:Organization
Organization Name:DEVELOPMENTAL DISABILITIES RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY RELATIONS DIRECTOR/CONTRA
Authorized Official - Prefix:
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNETT
Authorized Official - Suffix:
Authorized Official - Credentials:BS-QP
Authorized Official - Phone:704-573-9777
Mailing Address - Street 1:6824 WILGROVE MINT HILL RD
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-3428
Mailing Address - Country:US
Mailing Address - Phone:704-573-9777
Mailing Address - Fax:704-916-6656
Practice Address - Street 1:6824 WILGROVE MINT HILL RD
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-3428
Practice Address - Country:US
Practice Address - Phone:704-573-9777
Practice Address - Fax:704-916-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonaryGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental DisabilitiesGroup - Multi-Specialty
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409175Medicaid
NC6003417Medicaid
NC3419268Medicaid