Provider Demographics
NPI:1932531720
Name:PHP OF NC,INC
Entity Type:Organization
Organization Name:PHP OF NC,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-220-0021
Mailing Address - Street 1:700 PONY RD STE B
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-2656
Mailing Address - Country:US
Mailing Address - Phone:919-375-4702
Mailing Address - Fax:919-375-4838
Practice Address - Street 1:700 PONY RD STE B
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-2656
Practice Address - Country:US
Practice Address - Phone:919-375-4702
Practice Address - Fax:919-375-4838
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHP OF NC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services