NPIMap

Organization Active NPI

Brushy Mountain Group Homes, Inc

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • North Wilkesboro, NC
National Provider Identifier
1104939313
Registry record updated Jun 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
MHL097046 Issued in NC
Legal business name
BRUSHY MOUNTAIN GROUP HOMES, INC
Practice address
1224 Swain St
North Wilkesboro, NC 28659-3343
Phone
(336) 838-7220
Fax
(336) 838-3490
NPI assigned
Aug 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2008

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

Authorized official

Name
Mrs. Shelley Darlene Gamble
Title
Executive Director
Phone
(336) 838-3789

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL097046 NC Primary

Addresses

Primary practice location

1224 Swain St
North Wilkesboro, NC 28659-3343

Mailing address

PO Box 1045
North Wilkesboro, NC 28659-1045
Phone (336) 838-3789

Other identifiers 1

IdentifierTypeStateIssuer
7804483MedicaidNC

Other names 1

  • Swain Street Group Home Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Brushy Mountain Group Homes Inc3 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": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1104939313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1045",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286591045",
            "telephone_number": "336-838-3789",
            "fax_number": "336-838-3490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 SWAIN ST",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286593343",
            "telephone_number": "336-838-7220",
            "fax_number": "336-838-3490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUSHY MOUNTAIN GROUP HOMES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-15",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "GAMBLE",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "DARLENE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "336-838-3789",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL097046",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804483",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Swain Street Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Wilkesboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; 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.