Organization
J IVERSON RIDDLE DEVELOPMENT CENTER
Active
Other names
Western Carolina Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. J MICHAEL HENNIKE (SECTION CHIEF OF DMH DD SAS STATE O)
(919) 855-4700
Entity
Organization
Contact information
Practice address
300 ENOLA ROAD, MORGANTON, NC 28655-4608
(828) 433-2722
(828) 433-2724
Mailing address
300 ENOLA ROAD, MORGANTON, NC 28655-4608
(828) 433-2722
(828) 433-2724
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3406014
—
NC
Enumeration date
01/30/2007
Last updated
08/22/2020
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