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10 <br /> State of North Carolina <br /> Division of Social Services <br /> Contract Application Page 2 of <br /> E. Contrast Identification. <br /> 1. Provider <br /> a NameofCortractei Bryarf <br /> Tel.#: 732-8120 <br /> In U m F C Person: Aatotua Pldtoza <br /> Tel.#: 732-8124 <br /> c. Progratn Name,Location end Mailing Address: <br /> 500 Volley Fable Rd. <br /> urb NC12229 <br /> d. Additional Service Delivery Sites: <br /> e. Status : ( )Public (X)Private,non-profit <br /> ( )Pmate,for Profit( )Individual <br /> E Prouder Conunwill)# n%°tn— <br /> 2. CounwDeparronsentof Sec al ¢cm <br /> e nr Canvazt Admin'stmmr Nancy Cosmn <br /> a Tel.#: 2A5-2800 <br /> b. Name of C Prourvin Contact eveston. Gwen Price <br /> Tel.#: 245-2800 <br /> c � fC D eutof Social Sery <br /> 300 w Ti; on Strett <br /> Hillsbaciromiju,NC 27278 <br />