Provider Demographics
NPI:1932549482
Name:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL-TEACCH AUTISM PROGRAM
Entity Type:Organization
Organization Name:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL-TEACCH AUTISM PROGRAM
Other - Org Name:CHARLOTTE TEACCH AUTISM PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-966-8191
Mailing Address - Street 1:100 RENEE LYNN CT
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-6511
Mailing Address - Country:US
Mailing Address - Phone:919-966-2173
Mailing Address - Fax:919-966-4127
Practice Address - Street 1:5701 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 108
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8862
Practice Address - Country:US
Practice Address - Phone:704-563-4103
Practice Address - Fax:704-563-4112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL-TEACCH AUTISM PROGRAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3408563251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408563Medicaid