Provider Demographics
NPI:1427233972
Name:NC DEPT OF HEALTH AND HUMAN SERVICE/DVRS
Entity type:Organization
Organization Name:NC DEPT OF HEALTH AND HUMAN SERVICE/DVRS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, NCATP
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-855-3544
Mailing Address - Street 1:805 RUGGLES DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-2025
Mailing Address - Country:US
Mailing Address - Phone:919-855-3544
Mailing Address - Fax:919-715-1776
Practice Address - Street 1:3080 HAMMOND BUSINESS PL STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3666
Practice Address - Country:US
Practice Address - Phone:919-664-1244
Practice Address - Fax:919-715-1776
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NC DEPT OF HEALTH AND HUMAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-03
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200128Medicaid