Basic Information
| Provider Information | |||||||||
| NPI: | 1225207491 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RESOURCES FOR HUMAN DEVELOPMENT, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DURHAM AREA ADOLESCENT PROGRAM | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 811 UNDERWOOD AVE | ||||||||
| Address2: | APT. C-9 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277012988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194898717 | ||||||||
| FaxNumber: | 9194898904 | ||||||||
| Practice Location | |||||||||
| Address1: | 947 CLARION DR | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277051730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194898717 | ||||||||
| FaxNumber: | 9194898904 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2008 | ||||||||
| LastUpdateDate: | 02/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | FISHMAN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8008949925 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RESOURCES FOR HUMAN DEVELOPMENT, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | MHL 032413 | NC | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
ID Information
| ID | Type | State | Issuer | Description | 8301364 | 05 | NC | MEDICAID |