Evans Walston Home LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

MHL 092248 Issued in NC

Legal business name

EVANS WALSTON HOME LLC

Doing business as

Evans Walston Home

Practice address

808 Hawks View CT
Fuquay Varina, NC 27526-6642

Phone

(919) 552-1312

Fax

(919) 552-1312

NPI assigned

Dec 13, 2013

Last updated

Dec 13, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Glenda Judd Evans Walston

Title

Owner/Operator

Phone

(919) 552-1312

Specialties & licenses 1

Addresses

Other names 1

• Evans Walston Home Doing business as

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

{
    "created_epoch": "1386892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386892800000",
    "number": "1063843274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 HAWKS VIEW CT",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275266642",
            "telephone_number": "919-552-1312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 HAWKS VIEW CT",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275266642",
            "telephone_number": "919-552-1312",
            "fax_number": "919-552-1312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANS WALSTON HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-13",
        "last_updated": "2013-12-13",
        "status": "A",
        "authorized_official_last_name": "EVANS WALSTON",
        "authorized_official_first_name": "GLENDA",
        "authorized_official_middle_name": "JUDD",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "919-552-1312",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL 092248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evans Walston Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Fuquay Varina, NC
• Providers in Fuquay Varina, NC by specialty
• Intellectual and/or Developmental Disabilities 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 Dec 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.