Wallbrown Home Inc.

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

MHL 010 020 Issued in NC

Legal business name

WALLBROWN HOME INC.

Practice address

949 N Shore Dr
Southport, NC 28461-9578

Phone

(910) 845-3553

Fax

(910) 845-3607

NPI assigned

Jan 11, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Mark Henry Wallbrown

Title

Director

Phone

(910) 845-3553

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154471381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "949 N SHORE DR",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284619578",
            "telephone_number": "910-845-3553",
            "fax_number": "910-845-3607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "949 N SHORE DR",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284619578",
            "telephone_number": "910-845-3553",
            "fax_number": "910-845-3607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLBROWN HOME INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALLBROWN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "HENRY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "910-845-3553",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NC",
            "license": "MHL 010 020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3409239",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Developmentally Disabled Services Day Training Agency in Southport, NC
• Providers in Southport, NC by specialty
• Developmentally Disabled Services Day Training Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.