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Organization
CCDP INC
Active
Organization
CCDP INC
Active
Other names
Coastal Children's Developmental Program
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DONNA DAVIS (ASSISTANT DIRECTOR)
(252) 638-9046
Entity
Organization
Contact information
Practice address
6209 COUNTY LINE RD, NEW BERN, NC 28562-9478
(252) 638-5735
(252) 638-5735
Mailing address
1900 US HIGHWAY 70 E STE C, NEW BERN, NC 28560-6818
(252) 638-9046
(252) 638-9026
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-025-183
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011207
FACILITY ID
NC
01
—
MHL025183
LICENSE NUMBER
NC
Enumeration date
02/23/2007
Last updated
06/16/2008
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