Mary'S Home

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

.1300 Issued in NC

Legal business name

MARY'S HOME

Practice address

1808 Birchwood Dr SE
Wilson, NC 27893-6476

Phone

(252) 347-9705

NPI assigned

Sep 9, 2014

Organization subpart

No

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

Authorized official

Name

Ms. Dominique Tiarra Jones, CNA MED TECH,

Title

Owner and Director

Phone

(252) 347-9705

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1410220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410220800000",
    "number": "1215338231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1808 BIRCHWOOD DR SE",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278936476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1808 BIRCHWOOD DR SE",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278936476",
            "telephone_number": "252-347-9705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY'S HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-09",
        "last_updated": "2014-09-09",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "DOMINIQUE",
        "authorized_official_middle_name": "TIARRA",
        "authorized_official_title_or_position": "OWNER AND DIRECTOR",
        "authorized_official_telephone_number": "252-347-9705",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CNA MED TECH,"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": ".1300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Marshburn, PA-C
• Cornelius Devante Martin, DMD
• Leighanna Grace Martin, FNP-C
• Lewis Paul Martin, MD
• Melissa Martini, FNTP
• Carle Woodruff Mason Jr., DDS
• Joi M Massey, PT, CWS
• Kimberly Clifton Massey, RPH, CDE
• Vaughn Mitchell Matacale, M.D.
• Sanjusha Elsy Mathew

• Emotionally Disturbed Childrens' Residential Treatment Facility in Wilson, NC
• Providers in Wilson, 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 Sep 9, 2014; 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.