Organization
PIEDMONT RESIDENTIAL DEVELOPMENT CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHARON A LIPKE (FINANCE DIRECTOR)
(704) 788-2304
Entity
Organization
Contact information
Practice address
630 WILHELM PL NE, CONCORD, NC 28025-2532
(704) 788-2304
(704) 788-2951
Mailing address
PO BOX 909, CONCORD, NC 28026-0909
(704) 788-2304
(704) 788-2951
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL-013-019
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3406118
—
NC
Enumeration date
01/29/2007
Last updated
08/27/2012
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