Organization
MICHAEL'S PLACE INC.
Active
Organization
MICHAEL'S PLACE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALVETH JOYCE YOUNG MD (CO-OWNER)
(919) 957-7985
Entity
Organization
Contact information
Practice address
2815 CASCADILLA ST, DURHAM, NC 27704-4411
(919) 957-7985
(919) 957-7985
Mailing address
2815 CASCADILLA ST, DURHAM, NC 27704-4411
(919) 957-7985
(919) 957-7985
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
MHL-032-415
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL-032-415
NC
347C00000X
Private Vehicle
MHL-032-415
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6006190
—
NC
Enumeration date
09/21/2007
Last updated
10/27/2007
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