Provider Demographics
NPI:1154623338
Name:AMAZING KIDS OF NC, INC.
Entity type:Organization
Organization Name:AMAZING KIDS OF NC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:DUNBAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-767-7561
Mailing Address - Street 1:834 SAINT CATHERINES DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6639
Mailing Address - Country:US
Mailing Address - Phone:252-767-7561
Mailing Address - Fax:919-554-9670
Practice Address - Street 1:834 SAINT CATHERINES DR
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6639
Practice Address - Country:US
Practice Address - Phone:252-767-7561
Practice Address - Fax:919-554-9670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8303124Medicaid