NPIMap

Organization Active NPI

Mybrotherskeeper

  • Adult Mental Health Clinic/Center
  • Rocky Mount, NC
National Provider Identifier
1184748238
Registry record updated Jul 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
MHL064060 Issued in NC
Legal business name
MYBROTHERSKEEPER
Practice address
816 Paul St
Rocky Mount, NC 27803-3337
Phone
(252) 985-2735
Fax
(252) 985-1952
NPI assigned
Mar 16, 2007
Last updated
Jul 31, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2008

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

Authorized official

Name
Ms. Barbara Jean Wilson, OWNER
Title
Administrator
Phone
(252) 985-2735

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X MHL064060 NC Primary

Addresses

Primary practice location

816 Paul St
Rocky Mount, NC 27803-3337

Mailing address

816 Paul St
Rocky Mount, NC 27803-3337
Phone (252) 985-2735

Other identifiers 1

IdentifierTypeStateIssuer
7804401MedicaidNC

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217462400000",
    "number": "1184748238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "816 PAUL ST",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278033337",
            "telephone_number": "252-985-2735",
            "fax_number": "252-985-1952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "816 PAUL ST",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278033337",
            "telephone_number": "252-985-2735",
            "fax_number": "252-985-1952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYBROTHERSKEEPER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2008-07-31",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "252-985-2735",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NC",
            "license": "MHL064060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804401",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rocky Mount, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 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.