Brunswick Community College Interagency Program

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

MHL-010-001 Issued in NC

Legal business name

BRUNSWICK COMMUNITY COLLEGE INTERAGENCY PROGRAM

Practice address

50 College Rd NE
Bolivia, NC 28422-9021

Phone

(910) 755-7394

Fax

(910) 755-7493

NPI assigned

Jul 3, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Krista Anne Engels

Title

Director

Phone

(910) 755-7394

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Brunswick Community College Interagency Program2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Brunswick Community College Interagency Program

  • Case Management Agency
  • Supply, NC
  • NPI 1376688259
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372809600000",
    "number": "1689014748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 COLLEGE RD NE",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "284229021",
            "telephone_number": "910-755-7394",
            "fax_number": "910-755-7493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 COLLEGE RD NE",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "284229021",
            "telephone_number": "910-755-7394",
            "fax_number": "910-755-7493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUNSWICK COMMUNITY COLLEGE INTERAGENCY PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-03",
        "last_updated": "2013-07-03",
        "status": "A",
        "authorized_official_last_name": "ENGELS",
        "authorized_official_first_name": "KRISTA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "910-755-7394",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NC",
            "license": "MHL-010-001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3404933",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Adams Brann, MD
• Justin Bridge
• Nicholas Matthew Brooker, PT, DPT
• Laura Brown, M.ED, CCC-SLP
• Sara Johnson Brown, NP
• Brunswick Community Hospital, LLC
• Brunswick Community Hospital, LLC
• Brunswick Community Hospital, LLC
• Brunswick County Health Department
• Brunswick County Schools

• Developmentally Disabled Services Day Training Agency in Bolivia, NC
• Providers in Bolivia, NC by specialty
• Developmentally Disabled Services Day Training Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.