Carolina Prime Residential LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

CAROLINA PRIME RESIDENTIAL LLC

Practice address

315 Maple St
Eden, NC 27288-5513

Phone

(336) 623-1020

NPI assigned

Jul 15, 2020

Last updated

Apr 10, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Mikisha Simms

Title

Director

Phone

(301) 717-2040

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1594771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1215545348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 MAPLE ST",
            "city": "EDEN",
            "state": "NC",
            "postal_code": "272885513",
            "telephone_number": "336-763-5620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 MAPLE ST",
            "city": "EDEN",
            "state": "NC",
            "postal_code": "272885513",
            "telephone_number": "336-623-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA PRIME RESIDENTIAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-15",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A",
        "authorized_official_last_name": "SIMMS",
        "authorized_official_first_name": "MIKISHA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "301-717-2040",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael D Burleson, D.D.S.
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• Aaron Carpenter
• Joe Gray Carpenter, PT, DPT,OCS, FAAOMPT
• Erin Jones Carroll, PA-C
• Kelsey Carter
• Angel G Cassell, HOME CARE AID

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Eden, NC
• Providers in Eden, NC by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; 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.