NPIMap

Organization Active NPI

J Iverson Riddle Development Center

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Morganton, NC
National Provider Identifier
1932245487
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
J IVERSON RIDDLE DEVELOPMENT CENTER
Practice address
300 Enola Road
Morganton, NC 28655-4608
Phone
(828) 433-2722
Fax
(828) 433-2724
NPI assigned
Jan 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. J Michael Hennike
Title
Section Chief of DMH DD Sas State O
Phone
(919) 855-4700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X Primary

Addresses

Primary practice location

300 Enola Road
Morganton, NC 28655-4608

Mailing address

300 Enola Road
Morganton, NC 28655-4608
Phone (828) 433-2722

Other identifiers 1

IdentifierTypeStateIssuer
3406014MedicaidNC

Other names 1

  • Western Carolina Center Other name

National Provider Directory

National Provider Directory
Tax ID family
J Iverson Riddle Developmental Center12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1932245487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 ENOLA ROAD",
            "city": "MORGANTON",
            "state": "NC",
            "postal_code": "286554608",
            "telephone_number": "828-433-2722",
            "fax_number": "828-433-2724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 ENOLA ROAD",
            "city": "MORGANTON",
            "state": "NC",
            "postal_code": "286554608",
            "telephone_number": "828-433-2722",
            "fax_number": "828-433-2724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J IVERSON RIDDLE DEVELOPMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HENNIKE",
        "authorized_official_first_name": "J",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "SECTION CHIEF OF DMH DD SAS STATE O",
        "authorized_official_telephone_number": "919-855-4700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406014",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Western Carolina Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Morganton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.