Provider Demographics
NPI:1831276005
Name:JOHNSTON COUNTY INDUSTRIES, INC.
Entity type:Organization
Organization Name:JOHNSTON COUNTY INDUSTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-743-8702
Mailing Address - Street 1:1100 E PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:NC
Mailing Address - Zip Code:27576-3162
Mailing Address - Country:US
Mailing Address - Phone:919-743-8700
Mailing Address - Fax:919-965-8023
Practice Address - Street 1:1100 E PRESTON ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:NC
Practice Address - Zip Code:27576-3162
Practice Address - Country:US
Practice Address - Phone:919-743-8700
Practice Address - Fax:919-965-8023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408226Medicaid