Provider Demographics
NPI:1609074673
Name:CRUDUP, DAVID H
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:H
Last Name:CRUDUP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 OLD US HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:SPRING HOPE
Mailing Address - State:NC
Mailing Address - Zip Code:27882-9654
Mailing Address - Country:US
Mailing Address - Phone:252-478-8095
Mailing Address - Fax:
Practice Address - Street 1:1009 ALBEMARLE CT
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2502
Practice Address - Country:US
Practice Address - Phone:252-288-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-025-211320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness