Provider Demographics
NPI:1992913396
Name:MURPHY'S OUTREACH COMMUNITY DEVELOPMENTAL SERVICES
Entity type:Organization
Organization Name:MURPHY'S OUTREACH COMMUNITY DEVELOPMENTAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:DONTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-738-6767
Mailing Address - Street 1:210 E 2ND ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-5620
Mailing Address - Country:US
Mailing Address - Phone:910-738-6767
Mailing Address - Fax:910-345-8917
Practice Address - Street 1:210 E 2ND ST
Practice Address - Street 2:SUITE 125
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-5620
Practice Address - Country:US
Practice Address - Phone:910-738-6767
Practice Address - Fax:910-345-8917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2018251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301026BMedicaid
NC8301026Medicaid
NC6600760Medicaid
NC3409351Medicaid