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Active
Organization subpart
No

Provider details

NPI number
Authorized official
KESHA RIDGES (DIRECTOR)
(919) 776-6119
Entity
Organization

Contact information

Practice address
1309 WASHINGTON AVENUE, SANFORD, NC 27330
(919) 776-6119
Mailing address
1309 WASHINGTON AVENUE, SANFORD, NC 27330
(919) 776-6119

Taxonomy

Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
53000189
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1991
NC
Enumeration date
09/30/2013
Last updated
09/30/2013
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