Provider Demographics
NPI:1982767513
Name:DURHAM EXCHANGE CLUB INDUSTRIES
Entity Type:Organization
Organization Name:DURHAM EXCHANGE CLUB INDUSTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:919-596-1341
Mailing Address - Street 1:1717 E LAWSON ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-5025
Mailing Address - Country:US
Mailing Address - Phone:919-596-1341
Mailing Address - Fax:919-596-6380
Practice Address - Street 1:1717 E LAWSON ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-5025
Practice Address - Country:US
Practice Address - Phone:919-596-1341
Practice Address - Fax:919-596-6380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-032-379251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418222Medicaid