NPIMap

Organization Active NPI

Falcon Crest Residential Care

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Mebane, NC
National Provider Identifier
1104944081
Registry record updated Aug 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
MHL-001-103 Issued in NC
Legal business name
FALCON CREST RESIDENTIAL CARE
Practice address
1101 S Fifth St
Mebane, NC 27302-9182
Phone
(336) 226-2575
Fax
(336) 226-2474
NPI assigned
Mar 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2013

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

Authorized official

Name
Ms. Wendy Kay Bradsher
Title
Adm. Manager/Owner
Phone
(336) 226-2575

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 753096607 NC
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL-001-103 NC Primary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL-001-141 NC
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL-001-141 NC
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL-001-103 NC

Addresses

Primary practice location

1101 S Fifth St
Mebane, NC 27302-9182

Mailing address

1101 South Fifth Street
Mebane, NC 27302-1101
Phone (336) 226-2575

Other identifiers 3

IdentifierTypeStateIssuer
6603770MedicaidNC
6603998MedicaidNC
6603415MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Falcon Crest Residential Care4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377043200000",
    "number": "1104944081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 SOUTH FIFTH STREET",
            "city": "MEBANE",
            "state": "NC",
            "postal_code": "273021101",
            "telephone_number": "336-226-2575",
            "fax_number": "336-226-2474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 S FIFTH ST",
            "city": "MEBANE",
            "state": "NC",
            "postal_code": "273029182",
            "telephone_number": "336-226-2575",
            "fax_number": "336-226-2474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FALCON CREST RESIDENTIAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2013-08-21",
        "status": "A",
        "authorized_official_last_name": "BRADSHER",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "ADM. MANAGER/OWNER",
        "authorized_official_telephone_number": "336-226-2575",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "753096607",
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-001-103",
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-001-141",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-001-141",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-001-103",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603770",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603998",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603415",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mebane, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2013; 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.