Making a Difference Community Support LLC

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

License

261QR0400X Issued in NC

Legal business name

MAKING A DIFFERENCE COMMUNITY SUPPORT LLC

Practice address

102 Old Tom Ave.
Manteo, NC 27954

Phone

(252) 475-9829

NPI assigned

Oct 29, 2007

Last updated

Nov 1, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shanequa Cornise Benton

Title

Member/Organizer

Phone

(252) 475-9829

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1193616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193875200000",
    "number": "1912186735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7672",
            "city": "KILL DEVIL HILLS",
            "state": "NC",
            "postal_code": "279486672",
            "telephone_number": "252-475-9829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 OLD TOM AVE.",
            "city": "MANTEO",
            "state": "NC",
            "postal_code": "27954",
            "telephone_number": "252-475-9829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAKING A DIFFERENCE COMMUNITY SUPPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-29",
        "last_updated": "2007-11-01",
        "status": "A",
        "authorized_official_last_name": "BENTON",
        "authorized_official_first_name": "SHANEQUA",
        "authorized_official_middle_name": "CORNISE",
        "authorized_official_title_or_position": "MEMBER/ORGANIZER",
        "authorized_official_telephone_number": "252-475-9829"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NC",
            "license": "261QM0850X",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NC",
            "license": "261QM0855X",
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NC",
            "license": "261QR0400X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Hadra, DMD, PA (Shoreline Orthodontics)
• Leslie Faye Kendrick, DNP
• Kristen Kirchoff, MS
• Ian Kirkpatrick, PA-C
• Life, Inc. (Roanoke Trail Facility)
• Richard Joesph Martin, M.T.S., ED. D., LCAS
• Karen Grimes McPherson, FNP
• Monarch
• Katherine Ruth Moore
• Keith David Morris, RPH

• Rehabilitation Clinic/Center in Manteo, NC
• Providers in Manteo, NC by specialty
• Rehabilitation Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2007; 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.