Rose of Sharon Adolescent Treatment Home

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

MHL 032275 Issued in NC

Legal business name

ROSE OF SHARON ADOLESCENT TREATMENT HOME

Practice address

13 Rhyn CT
Durham, NC 27704-2359

Phone

(919) 220-2492

Fax

(919) 550-2648

NPI assigned

Jan 27, 2007

Organization subpart

Yes

Parent organization

ROSE OF SHARON ADOLESCENT TREATMENT HOMEAs reported in NPPES

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

Authorized official

Name

Mrs. Sharon W Pettiford

Title

Ceo-Owner

Phone

(919) 550-2648

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Rose of Sharon Adolescent Treatment Home

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

{
    "created_epoch": "1169856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1194871483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 KENTUCKY DERBY DR",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275206080",
            "telephone_number": "919-550-2648",
            "fax_number": "919-220-1185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 RHYN CT",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277042359",
            "telephone_number": "919-220-2492",
            "fax_number": "919-550-2648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSE OF SHARON ADOLESCENT TREATMENT HOME",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ROSE OF SHARON ADOLESCENT TREATMENT HOME",
        "enumeration_date": "2007-01-27",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "PETTIFORD",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO-OWNER",
        "authorized_official_telephone_number": "919-550-2648",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL 032275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603291",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Judith Noemy Rosales Valdes, PA-C
• Lashaunda Rosario, LCSWA
• Roberto Beaumont Rosario, MD,MA,MACC, MBA,CPA
• Kristine Sue Rosati, QMHP
• Jullia Rosdahl, M.D.
• Alisa Rose
• Anelia P Rose, M.D.
• Cynthia Marcia Rose, RN
• Debra Rose, BT
• Eleanor Rose

• Emotionally Disturbed Childrens' Residential Treatment Facility in Durham, NC
• Providers in Durham, 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 Jun 16, 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.