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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
DONNA RUFF (OWNER)
(704) 906-1225
Entity
Organization

Contact information

Practice address
1409 EAST BLVD, CHARLOTTE, NC 28203-5817
(704) 906-1225
Mailing address
1409 EAST BLVD, CHARLOTTE, NC 28203-5817

Taxonomy

Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
HC1917
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3409241
NC
Enumeration date
02/04/2009
Last updated
02/04/2009
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