Stehanie D Wall

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

MHL-047-152 Issued in NC

Practice address

1357 Wayside Rd
Raeford, NC 28376-6513

Phone

(910) 565-2139

NPI assigned

Dec 12, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1386806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420761600000",
    "number": "1083045306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3204 HIGH PLAINS DR",
            "city": "HOPE MILLS",
            "state": "NC",
            "postal_code": "283485726",
            "telephone_number": "910-674-8605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1357 WAYSIDE RD",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283766513",
            "telephone_number": "910-565-2139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "STEHANIE",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-12-12",
        "last_updated": "2015-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL-047-152",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "SC",
            "license": "27-0962043",
            "primary": false
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "SC",
            "license": "27-0962043",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083045306",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE FUND",
            "identifier": "1083045306",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Illness Community Based Residential Treatment Facility in Raeford, NC
• Providers in Raeford, 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 9, 2015; 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.