Bynum's-Way Adolescent Treatment Home

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

073055 Issued in NC

Legal business name

BYNUM'S-WAY ADOLESCENT TREATMENT HOME

Practice address

4700 Virgilina Rd
Roxboro, NC 27574-8307

Phone

(336) 592-5625

Fax

(919) 550-2648

NPI assigned

Jul 15, 2009

Last updated

Jul 15, 2009By 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

Ms. Lora P Bynum

Title

Ceo

Phone

(336) 592-5625

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1247616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247616000000",
    "number": "1114157989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 VIRGILINA RD",
            "city": "ROXBORO",
            "state": "NC",
            "postal_code": "275748307",
            "telephone_number": "336-592-5625",
            "fax_number": "919-550-2648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 VIRGILINA RD",
            "city": "ROXBORO",
            "state": "NC",
            "postal_code": "275748307",
            "telephone_number": "336-592-5625",
            "fax_number": "919-550-2648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BYNUM'S-WAY ADOLESCENT TREATMENT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-15",
        "last_updated": "2009-07-15",
        "status": "A",
        "authorized_official_last_name": "BYNUM",
        "authorized_official_first_name": "LORA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "336-592-5625",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "073055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH LICENSE",
            "identifier": "073055",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jalonta Brogdon
• Dallas Ray Brooks, PHARMD
• Herbert Clifford Brown, LCSWA
• Jenna Marie Bryan
• Wendy P Bush, CRNA
• Derek Calkins, D.O.
• Cambridge Hills Alf Opco LLC (Cambridge Hills Assisted Living)
• Cambridge Hills Assisted Living Inc
• Halbert Eugene Campbell III, DDS
• Cardiovascular Care of Northern Carolina PA

• Emotionally Disturbed Childrens' Residential Treatment Facility in Roxboro, NC
• Providers in Roxboro, NC by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2009; 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.