A Place of My Own, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

A PLACE OF MY OWN, LLC

Practice address

315 Lower Pond Rd
Kannapolis, NC 28083-6526

Phone

(704) 925-1158

Fax

(855) 975-3055

NPI assigned

Nov 30, 2020

Last updated

Aug 27, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Toi Jackson

Title

Owner

Phone

(704) 965-7210

Specialties & licenses 4

Addresses

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

{
    "created_epoch": "1606694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1093319170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 LOWER POND RD",
            "city": "KANNAPOLIS",
            "state": "NC",
            "postal_code": "280836526",
            "telephone_number": "704-925-1158",
            "fax_number": "855-975-3055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 LOWER POND RD",
            "city": "KANNAPOLIS",
            "state": "NC",
            "postal_code": "280836526",
            "telephone_number": "704-925-1158",
            "fax_number": "855-975-3055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A PLACE OF MY OWN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-30",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-26",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "TOI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-965-7210"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; 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.