NPIMap

Organization Active NPI

Pitt County Group Home Board for Mentally Retarded, Autistic Persons,

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Winterville, NC
National Provider Identifier
1164772489
Registry record updated Sep 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
MHL-074-037 Issued in NC
Legal business name
PITT COUNTY GROUP HOME BOARD FOR MENTALLY RETARDED, AUTISTIC PERSONS,
Practice address
2240 Edgewater Dr
Winterville, NC 28590-9601
Phone
(252) 524-4950
Fax
(252) 524-3870
NPI assigned
Sep 13, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2012

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

Authorized official

Name
Mary Grace Bright
Title
Executive Director
Phone
(252) 524-4950

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL-074-037 NC Primary

Addresses

Primary practice location

2240 Edgewater Dr
Winterville, NC 28590-9601

Mailing address

PO Box 9
Grifton, NC 28530-0009
Phone (252) 524-4950

Other identifiers 1

IdentifierTypeStateIssuer
7802610MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Pitt County Group Home Board for Mentally Retarded Autistic Persons6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1347494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347494400000",
    "number": "1164772489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "GRIFTON",
            "state": "NC",
            "postal_code": "285300009",
            "telephone_number": "252-524-4950",
            "fax_number": "252-524-3870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2240 EDGEWATER DR",
            "city": "WINTERVILLE",
            "state": "NC",
            "postal_code": "285909601",
            "telephone_number": "252-524-4950",
            "fax_number": "252-524-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PITT COUNTY GROUP HOME BOARD FOR MENTALLY RETARDED, AUTISTIC PERSONS,",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-13",
        "last_updated": "2012-09-13",
        "status": "A",
        "authorized_official_last_name": "BRIGHT",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "GRACE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "252-524-4950"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-074-037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7802610",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winterville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2012; 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.