Davie County Group Home, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

MHL-030-021 Issued in NC

Legal business name

DAVIE COUNTY GROUP HOME, INC.

Practice address

785 Sanford Ave
Mocksville, NC 27028-9700

Phone

(336) 751-5014

Fax

(336) 751-0036

NPI assigned

Oct 19, 2006

Organization subpart

No

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

Authorized official

Name

Judy P. Rosser

Title

Executive Director

Phone

(336) 751-5014

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194807552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "785 SANFORD AVE",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "270289700",
            "telephone_number": "336-751-5014",
            "fax_number": "336-751-0036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "785 SANFORD AVE",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "270289700",
            "telephone_number": "336-751-5014",
            "fax_number": "336-751-0036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVIE COUNTY GROUP HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROSSER",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "336-751-5014"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-030-021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3418213",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804494",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301090",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Davie Co Emergency Health Corp
• Davie County Board of Education
• Davie County Emergency Health Corp
• Davie County Emergency Health Corp
• Davie County Emergency Health Corp
• Davie County Health Department
• Davie County Health Department
• Davie County Health Department
• Davie County Health Department
• Davie County Hospital Primary Care

• All providers in Mocksville, NC
• Intellectual and/or Developmental Disabilities Residential Treatment Facility 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.