Basic Information
| Provider Information | |||||||||
| NPI: | 1497875603 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARTNERSHIP FOR A DRUG FREE NC, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 665 W 4TH ST | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271012701 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 320 E LEE AVE | ||||||||
| Address2: | |||||||||
| City: | YADKINVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270558132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366798805 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MATKINS | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 3367143376 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 5904280 | 05 | NC | MEDICAID |