NPIMap

Organization Active NPI

Full Potential, LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Lumberton, NC
National Provider Identifier
1083747828
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
MHL-078-188 Issued in NC
Legal business name
FULL POTENTIAL, LLC
Practice address
177 Cardinal Ave
Lumberton, NC 28360-9386
Phone
(910) 670-1989
NPI assigned
Mar 13, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jerome Johnson
Title
Director
Phone
(910) 670-1989

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X MHL-078-188 NC Primary

Addresses

Primary practice location

177 Cardinal Ave
Lumberton, NC 28360-9386

Mailing address

177 Cardinal Ave
Lumberton, NC 28360-9386

Other identifiers 1

IdentifierTypeStateIssuer
6604094MedicaidNC

Other names 1

  • Full Potential At Pembroke Other name

National Provider Directory

National Provider Directory
Tax ID family
Full Potential at Pembroke3 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.

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083747828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "177 CARDINAL AVE",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283609386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "177 CARDINAL AVE",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283609386",
            "telephone_number": "910-670-1989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL POTENTIAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JEROME",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "910-670-1989"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL-078-188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604094",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Full Potential At Pembroke",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lumberton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.