Provider Demographics
NPI:1649506957
Name:WOODBRIDGE ALTERNATIVE INC
Entity type:Organization
Organization Name:WOODBRIDGE ALTERNATIVE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ACCOUNTS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-580-2898
Mailing Address - Street 1:225 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-3203
Mailing Address - Country:US
Mailing Address - Phone:910-878-0351
Mailing Address - Fax:910-878-0362
Practice Address - Street 1:225 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3203
Practice Address - Country:US
Practice Address - Phone:910-878-0351
Practice Address - Fax:910-878-0362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty