Organization
IFCS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY PATRICIA RODENBERG-ROBERTS (VP & SR. ASST GENERAL COUNSEL)
(952) 836-2234
Entity
Organization
Contact information
Practice address
3125 POPLARWOOD CT STE 300, RALEIGH, NC 27604-6445
(919) 790-8580
Mailing address
3125 POPLARWOOD CT STE 300, RALEIGH, NC 27604-6445
(919) 790-8580
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
A10110
NC
305R00000X
Preferred Provider Organization
A10110
NC
Other
Enumeration date
11/08/2013
Last updated
05/07/2024
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