Provider Demographics
NPI:1316095052
Name:ROANOKE DEVELOPMENTAL CENTER INC
Entity type:Organization
Organization Name:ROANOKE DEVELOPMENTAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ZEBEDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, PHD
Authorized Official - Phone:252-793-5077
Mailing Address - Street 1:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NC
Mailing Address - Zip Code:27962-0967
Mailing Address - Country:US
Mailing Address - Phone:252-793-5077
Mailing Address - Fax:252-793-9144
Practice Address - Street 1:609 ADAMS ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-1813
Practice Address - Country:US
Practice Address - Phone:252-793-5077
Practice Address - Fax:252-793-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-094-002251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804441Medicaid
NC7804498Medicaid
NC8300667Medicaid
NC3408386Medicaid
NC7804439Medicaid
NC7804440Medicaid