Provider Demographics
NPI:1780870600
Name:MACON PROGRAM FOR PROGRESS, INC
Entity type:Organization
Organization Name:MACON PROGRAM FOR PROGRESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-524-4471
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28744-0700
Mailing Address - Country:US
Mailing Address - Phone:828-524-4471
Mailing Address - Fax:828-524-0823
Practice Address - Street 1:350 ORCHARD VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28744
Practice Address - Country:US
Practice Address - Phone:828-524-4471
Practice Address - Fax:828-524-0823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3403415251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300024KMedicaid