The Durham Family Group Home 'Lodge Street House'

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

MHL032393 Issued in NC

Legal business name

THE DURHAM FAMILY GROUP HOME 'LODGE STREET HOUSE'

Practice address

203 Lodge St
Durham, NC 27707-2339

Phone

(919) 682-5375

Fax

(919) 682-5375

NPI assigned

Feb 19, 2007

Last updated

Aug 28, 2007By 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. Susan Cox Durham, LPN

Title

Owner

Phone

(919) 730-7405

Specialties & licenses 1

Addresses

Tax ID family

Golden Years Family Care Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Susan Durham

  dba Golden Years Family Care Home

  • Adult Care Home Facility
  • Roxboro, NC
  • NPI 1437293594
  NPD tax ID

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

{
    "created_epoch": "1171843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188259200000",
    "number": "1245374545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 LODGE ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277072339",
            "telephone_number": "919-682-5375",
            "fax_number": "919-682-5375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 LODGE ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277072339",
            "telephone_number": "919-682-5375",
            "fax_number": "919-682-5375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DURHAM FAMILY GROUP HOME 'LODGE STREET HOUSE'",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-19",
        "last_updated": "2007-08-28",
        "status": "A",
        "authorized_official_last_name": "DURHAM",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "COX",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-730-7405",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "NC",
            "license": "MHL032393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Mental Illness) in Durham, NC
• Providers in Durham, NC by specialty
• Assisted Living Facility (Mental Illness) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 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.