Union Avenue Group Home II

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

MHL-041-1080 Issued in NC

Legal business name

UNION AVENUE GROUP HOME II

Practice address

605 Whitsett Ave
Gibsonville, NC 27249-2042

Phone

(336) 214-3028

NPI assigned

Apr 9, 2014

Organization subpart

No

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

Authorized official

Name

Mary N Woods

Title

Owner

Phone

(336) 214-3028

Specialties & licenses 1

Addresses

Tax ID family

210 Union Avenue Group Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• 210 Union Avenue Group Home

  • Assisted Living Facility (Mental Illness)
  • Burlington, NC
  • NPI 1821312521
  NPD tax ID

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

{
    "created_epoch": "1397001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397088000000",
    "number": "1083033716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 WHITSETT AVE",
            "city": "GIBSONVILLE",
            "state": "NC",
            "postal_code": "272492042",
            "telephone_number": "336-214-3028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 WHITSETT AVE",
            "city": "GIBSONVILLE",
            "state": "NC",
            "postal_code": "272492042",
            "telephone_number": "336-214-3028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNION AVENUE GROUP HOME II",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-09",
        "last_updated": "2014-04-10",
        "status": "A",
        "authorized_official_last_name": "WOODS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-214-3028"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "MHL-041-1080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Special Care
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• Alicia Dawn Sutton, MS, QP, LCAS-A
• Touch of Love Family Care
• Jerdean Truedsale, CASE MANAGER EC
• Watson Group Homes, Inc.
• Penny Annette Williams, CMF
• William Wilson
• Wound Healing Consultants

• Adult Care Home Facility in Gibsonville, NC
• Providers in Gibsonville, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2014; 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.