NPIMap

Organization Active NPI

Brushy Mountain Group Homes, Inc

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • North Wilkesboro, NC
National Provider Identifier
1205940129
Registry record updated Jun 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
MHL097045 Issued in NC
Legal business name
BRUSHY MOUNTAIN GROUP HOMES, INC
Doing business as
Holly Hills Group Home
Practice address
179 Holly Brook St
North Wilkesboro, NC 28659-8754
Phone
(336) 670-9352
Fax
(336) 838-3490
NPI assigned
Aug 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2008

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

Authorized official

Name
Mrs. Shelley Darlene Gamble
Title
Executive Director
Phone
(336) 838-3789

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL097045 NC Primary

Addresses

Primary practice location

179 Holly Brook St
North Wilkesboro, NC 28659-8754

Mailing address

PO Box 1045
North Wilkesboro, NC 28659-1045
Phone (336) 838-3789

Other identifiers 1

IdentifierTypeStateIssuer
7804482MedicaidNC

Other names 1

  • Holly Hills Group Home Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Brushy Mountain Group Homes Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

179 Holly Brook St
North Wilkesboro, NC 28659
Phone (336) 670-9352

NPI Registry JSON

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1205940129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1045",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286591045",
            "telephone_number": "336-838-3789",
            "fax_number": "336-838-3490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "179 HOLLY BROOK ST",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286598754",
            "telephone_number": "336-670-9352",
            "fax_number": "336-838-3490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUSHY MOUNTAIN GROUP HOMES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "GAMBLE",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "DARLENE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "336-838-3789",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL097045",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804482",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holly Hills Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Wilkesboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 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.