Provider Demographics
NPI:1023133709
Name:THE ENRICHMENT CENTER-AN AFFILIATED CHAPTER OF THE ARC
Entity type:Organization
Organization Name:THE ENRICHMENT CENTER-AN AFFILIATED CHAPTER OF THE ARC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-837-6824
Mailing Address - Street 1:1006 S MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-5815
Mailing Address - Country:US
Mailing Address - Phone:336-777-0076
Mailing Address - Fax:336-777-0520
Practice Address - Street 1:1006 S MARSHALL ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101
Practice Address - Country:US
Practice Address - Phone:336-777-0076
Practice Address - Fax:336-777-0520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-034-047251C00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301142Medicaid
NC3408920Medicaid
NC8301142BMedicaid