Eason Court Group Home LLC #2

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

MHL 035 050 Issued in NC

Legal business name

EASON COURT GROUP HOME LLC #2

Practice address

124 Gregory MNR
Youngsville, NC 27596-9614

Phone

(919) 556-5355

Fax

(866) 285-8824

NPI assigned

Jan 24, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sonja Denise Williams

Title

Assistant Director

Phone

(571) 288-4144

Specialties & licenses 2

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Eason Court3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Eason Court

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Youngsville, NC
  • NPI 1396864740
  NPD tax ID
• Eason Court Group Home

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Youngsville, NC
  • NPI 1790861334
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1485216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485216000000",
    "number": "1003353475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 759",
            "city": "YOUNGSVILLE",
            "state": "NC",
            "postal_code": "275960759",
            "telephone_number": "919-556-5355",
            "fax_number": "866-285-8824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 GREGORY MNR",
            "city": "YOUNGSVILLE",
            "state": "NC",
            "postal_code": "275969614",
            "telephone_number": "919-556-5355",
            "fax_number": "866-285-8824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASON COURT GROUP HOME LLC #2",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-24",
        "last_updated": "2017-01-24",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "SONJA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "ASSISTANT  DIRECTOR",
        "authorized_official_telephone_number": "571-288-4144"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL 035 050",
            "primary": true
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL 035 029",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804575",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin Brooke Doser, MA, CCC-SLP
• Maaran Luke Durham, MA, CCC-SLP
• E.Smoak Ackerman PLLC
• Eason Court
• Eason Court Group Home
• Family Preservation Services of NC, Inc - Long Mill Elementary
• Cynthia Sparta Farmer, LCMHC, NCC
• Tonya Renee Ferguson, CPSS
• Lisa Buffaloe Fields, MSN, RN, CNS,
• Zena Diane Fletcher, LMFTA

• Mental Illness Community Based Residential Treatment Facility in Youngsville, NC
• Providers in Youngsville, NC by specialty
• Mental Illness Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.