Pelham Group Home #1

LBN: Pelham Supportive Services
Pelham Group Home #1 is an health care organization with primary practice located at 1712 Shiloh Dr , Fayetteville NC 28304-4027. The organization recently has only one registered license in Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Illness, which is considered as the primary health care specialty. Pelham Supportive Services can be contacted via phone (910) 423-2800, or through Wilson, Mildred via phone (910) 630-6757.

Contact Information

Primary practice address
1712 Shiloh Dr Fayetteville NC 28304-4027
Phone: (910) 423-2800
Fax: (910) 423-2800
Website:
Map and Directions
Authorized official contact:
Name: Wilson, Mildred
Phone: (910) 630-6757

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Illness 320800000X MHL-026-823 North Carolina

Profile Details

NPI number 1760544712
LBN Legal business name Pelham Supportive Services
DBA Doing business as Pelham Group Home #1
Authorized official Wilson, Mildred
Entity Organization
Organization subpart 1 No
Enumeration date Dec 15th, 2006
Last updated Jul 10th, 2013 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1760544712 NPPES
North Carolina MEDICAID 7806025

Popular Providers