NPIMap

Organization Active NPI

Kountry Trails

  • Developmentally Disabled Services Day Training Agency
  • Pembroke, NC
National Provider Identifier
1235281098
Registry record updated Oct 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
License
MHL078154 Issued in NC
Legal business name
KOUNTRY TRAILS
Practice address
527 Woods Rd
Pembroke, NC 28372-8099
Phone
(910) 521-7788
Fax
(910) 521-7788
NPI assigned
Jan 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2007

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

Authorized official

Name
Jane Johnson
Title
Owner
Phone
(910) 521-7788

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X MHL078154 NC Primary

Addresses

Primary practice location

527 Woods Rd
Pembroke, NC 28372-8099

Mailing address

PO Box 925
Pembroke, NC 28372-0925
Phone (910) 521-7788

Other identifiers 1

IdentifierTypeStateIssuer
8301033MedicaidNC

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191542400000",
    "number": "1235281098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 925",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283720925",
            "telephone_number": "910-521-7788",
            "fax_number": "910-521-7788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "527 WOODS RD",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283728099",
            "telephone_number": "910-521-7788",
            "fax_number": "910-521-7788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOUNTRY TRAILS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2007-10-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-521-7788"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NC",
            "license": "MHL078154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301033",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2007; 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.