The Door of Life Residential Services

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

MHL043069 Issued in NC

Legal business name

THE DOOR OF LIFE RESIDENTIAL SERVICES

Practice address

227 Constitution Way
Cameron, NC 28326-9296

Phone

(336) 420-3195

NPI assigned

Mar 12, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Harvey W Campbell

Title

Ceo

Phone

(336) 420-3195

Specialties & licenses 1

Addresses

Tax ID family

The Door of Life Residential Services2 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.

• The Door of Life Residential Services

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Cameron, NC
  • NPI 1285826503
  NPD tax ID

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1265564314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 BRAMBER PL",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295273177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 CONSTITUTION WAY",
            "city": "CAMERON",
            "state": "NC",
            "postal_code": "283269296",
            "telephone_number": "336-420-3195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DOOR OF LIFE RESIDENTIAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-12",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "HARVEY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "336-420-3195",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL043069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Nicole Sunday
• Amanda Marie Swanson, BCBA
• Synergetic Functional Nutrition & Wellness Clinic
• Sara Ann Taylor
• Tara T Taylor
• The Door of Life Residential Services
• Sandra Faye Thompson, LCASA
• Lashaunda Tibbs
• Cassandra L Tillman, PT
• Tip Top Transportation LLC

• Mental Illness Community Based Residential Treatment Facility in Cameron, NC
• Providers in Cameron, 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 Jun 24, 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.