Edwards Group Home 3

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

MHL040026 Issued in NC

Legal business name

EDWARDS GROUP HOME 3

Practice address

1233 Appletree Road
Stantonsburg, NC 27833

Phone

(252) 747-4000

Fax

(252) 747-2602

NPI assigned

Mar 7, 2007

Last updated

Jan 10, 2008By 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

Thomas McCollumNPI 1972633691

Title

Ceo

Phone

(252) 747-4000

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Thomas McCollum

  • Mental Illness Community Based Residential Treatment Facility
  • Snow Hill, NC
  • NPI 1972633691
  Authorized official Same address or phone

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199923200000",
    "number": "1245360387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 295",
            "city": "SNOW HILL",
            "state": "NC",
            "postal_code": "285800295",
            "telephone_number": "252-747-4000",
            "fax_number": "252-747-2602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 APPLETREE ROAD",
            "city": "STANTONSBURG",
            "state": "NC",
            "postal_code": "27833",
            "telephone_number": "252-747-4000",
            "fax_number": "252-747-2602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARDS GROUP HOME 3",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2008-01-10",
        "status": "A",
        "authorized_official_last_name": "MCCOLLUM",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "252-747-4000"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL040026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie's Family Care Home
• Circle of Love Family Care Home LLC.
• Easter Seals Ucp North Carolina & Virginia Inc.
• Edwards Group Home 4
• Melody Meeks Flannery, MS, LCMHCA, LCAS, CR
• Life, Inc. (Wilson Dda)
• Stantonsburg Drug Company, Inc
• Stantonsburg Drug Company, Inc

• Mental Illness Community Based Residential Treatment Facility in Stantonsburg, NC
• Providers in Stantonsburg, NC by specialty
• Mental Illness 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 Jan 10, 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.