NPIMap

Organization Active NPI

Mid-State Health Systems, Inc

Doing business as Thomas S Decatur Home

  • Intellectual Disabilities Intermediate Care Facility
  • Fayetteville, NC
National Provider Identifier
1083056782
Registry record updated Dec 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
MHL-026-944 Issued in NC
Legal business name
MID-STATE HEALTH SYSTEMS, INC
Doing business as
Thomas S Decatur Home
Practice address
7559 Decatur Dr
Fayetteville, NC 28303-1989
Phone
(910) 484-3717
Fax
(910) 484-1315
NPI assigned
Jul 23, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2015

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

Authorized official

Name
Sera Gilmore
Title
Administrator
Phone
(910) 484-3717

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X MHL-026-944 NC Primary

Addresses

Primary practice location

7559 Decatur Dr
Fayetteville, NC 28303-1989

Mailing address

3721 Legion Rd
Hope Mills, NC 28348-8411
Phone (910) 484-3717

Other names 1

  • Thomas S Decatur Home Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 34G239

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
THOMAS S DECATUR HOME
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jul 15, 1992
Last certification
Jun 10, 2025
Beds
6
Ownership / control type
Private (proprietary)
Facility address
7559 Decatur Drive
Fayetteville, NC 28303

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2271409Thomas S Decatur Group Home7559 Decatur Dr, Fayetteville, NC 28303Certificate of waiverNov 1, 2026

National Provider Directory

National Provider Directory
Tax ID family
Mid-State Health Systems Inc12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

3721 Legion Rd
Hope Mills, NC 28348
Phone (910) 484-3148

NPI Registry JSON

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

{
    "created_epoch": "1374537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449446400000",
    "number": "1083056782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3721 LEGION RD",
            "city": "HOPE MILLS",
            "state": "NC",
            "postal_code": "283488411",
            "telephone_number": "910-484-3717",
            "fax_number": "910-484-1315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7559 DECATUR DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283031989",
            "telephone_number": "910-484-3717",
            "fax_number": "910-484-1315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-STATE HEALTH SYSTEMS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-23",
        "last_updated": "2015-12-07",
        "status": "A",
        "authorized_official_last_name": "GILMORE",
        "authorized_official_first_name": "SERA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "910-484-3717"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": "MHL-026-944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Thomas S Decatur Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.