Provider Demographics
NPI:1013276914
Name:J. IVERSON DEVELOPMENTAL CENTER
Entity Type:Organization
Organization Name:J. IVERSON DEVELOPMENTAL CENTER
Other - Org Name:FAMILY, INFANT AND PRESCHOOL PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:CORNETT
Authorized Official - Suffix:
Authorized Official - Credentials:BSBS, BACC
Authorized Official - Phone:828-608-6703
Mailing Address - Street 1:300 ENOLA RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 ENOLA RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4608
Practice Address - Country:US
Practice Address - Phone:828-608-6700
Practice Address - Fax:828-438-6457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200456Medicaid