Provider Demographics
NPI:1356436117
Name:LEE COUNTY INDUSTRIES, INC.
Entity type:Organization
Organization Name:LEE COUNTY INDUSTRIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:DAY
Authorized Official - Last Name:KOGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-775-3439
Mailing Address - Street 1:2711 TRAMWAY RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-7140
Mailing Address - Country:US
Mailing Address - Phone:919-775-3439
Mailing Address - Fax:919-774-6926
Practice Address - Street 1:2711 TRAMWAY RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-7140
Practice Address - Country:US
Practice Address - Phone:919-775-3439
Practice Address - Fax:919-774-6926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408600Medicaid