NPIViewer - Provider NPI 1295874527

NPI:	1295874527
Name:	WOODBRIDGE ALTERNATIVE, INC
Entity type:	Organization
Organization Name:	WOODBRIDGE ALTERNATIVE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:	VICE-PRESIDENT
Authorized Official - Prefix:	MR
Authorized Official - First Name:	LEON
Authorized Official - Middle Name:
Authorized Official - Last Name:	ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:	910-488-9570
Mailing Address - Street 1:	1480 PAMALEE DRIIVE
Mailing Address - Street 2:
Mailing Address - City:	FAYETTEVILLE
Mailing Address - State:	NC
Mailing Address - Zip Code:	28303-3928
Mailing Address - Country:	US
Mailing Address - Phone:	910-488-9570
Mailing Address - Fax:	910-822-0111
Practice Address - Street 1:	1480 PAMALEE DR
Practice Address - Street 2:
Practice Address - City:	FAYETTEVILLE
Practice Address - State:	NC
Practice Address - Zip Code:	28303-3928
Practice Address - Country:	US
Practice Address - Phone:	910-488-9570
Practice Address - Fax:	910-822-0111
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2007-02-05
Last Update Date:	2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:

Primary?	Code	Type	Classification
Yes	251S00000X	Agencies	Community/Behavioral Health
No	320800000X	Residential Treatment Facilities	Community Based Residential Treatment Facility, Mental Illness
No	322D00000X	Residential Treatment Facilities	Residential Treatment Facility, Emotionally Disturbed Children

State	Identifier ID	ID Type
NC	6603588	Medicaid
NC	6603284	Medicaid
NC	6603733	Medicaid
NC	6603283	Medicaid
NC	8301341B	Medicaid
NC	6005215	Medicaid
NC	6005216	Medicaid
NC	6603044	Medicaid
NC	6603046	Medicaid
NC	6603282	Medicaid
NC	6603589	Medicaid
NC	8301341H	Medicaid
NC	6603603	Medicaid
NC	8301341G	Medicaid
NC	6603045	Medicaid
NC	6603136	Medicaid
NC	6603233	Medicaid
NC	6603325	Medicaid
NC	8301341	Medicaid