Adolescent Care Center

Primary specialty

Student Health Clinic/CenterTaxonomy code 261QS1000X

Legal business name

ADOLESCENT CARE CENTER

Practice address

88 US Highway 158 W
Gatesville, NC 27938-9438

Phone

(252) 357-1244

Fax

(252) 357-1690

NPI assigned

Aug 21, 2007

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

GATES COUNTY MEDICAL CENTERAs reported in NPPES

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

Authorized official

Name

Syliva Boone, R.N.

Title

Office Manager

Phone

(252) 357-1226

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Adolescent Care Center

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Gates County Medical Center LLC

  • Primary Care Clinic/Center
  • Gatesville, NC
  • NPI 1639217631
  NPPES parent name

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

{
    "created_epoch": "1187654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1083807325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "88 US HIGHWAY 158 W",
            "city": "GATESVILLE",
            "state": "NC",
            "postal_code": "279389438",
            "telephone_number": "252-357-1244",
            "fax_number": "252-357-1690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 US HIGHWAY 158 W",
            "city": "GATESVILLE",
            "state": "NC",
            "postal_code": "279389438",
            "telephone_number": "252-357-1244",
            "fax_number": "252-357-1690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADOLESCENT CARE CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GATES COUNTY MEDICAL CENTER",
        "enumeration_date": "2007-08-21",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BOONE",
        "authorized_official_first_name": "SYLIVA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "252-357-1226",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8701702",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Rae Anderson, LPTA
• Associates United Corporation (Community Services For Family Support)
• Abigail Claudia Bivans, PA-C
• Julia Blackwell, CRNP
• James Wayne Blanton, PAC

• Student Health Clinic/Center in Gatesville, NC
• Providers in Gatesville, NC by specialty
• Student Health Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.