Organization
PHP OF NC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTINE WIGGINS (EXECUTIVE DIRECTOR)
(919) 220-0021
Entity
Organization
Contact information
Practice address
4125 BEN FRANKLIN BLVD, SUITE 180, DURHAM, NC 27704-2167
(919) 220-0021
(919) 220-4555
Mailing address
PO BOX 20014, DURHAM, NC 27707-0027
(919) 220-0021
(919) 220-4555
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
MHL-032-255
NC
251E00000X
Home Health Agency
HC1631
NC
251S00000X
Community/Behavioral Health Agency
MHL-0320255
NC
253Z00000X
In Home Supportive Care Agency
MHL-032-255
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-032-133
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-032-149
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-032-245
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-032-349
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408783
—
NC
05
—
6600586
—
NC
Enumeration date
08/29/2006
Last updated
05/10/2017
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