Active NPI
Moore Bynum
- Emotionally Disturbed Childrens' Residential Treatment Facility
- Rocky Mount, NC
National Provider Identifier
1265619274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emotionally Disturbed Childrens' Residential Treatment Facility
- License
- MHL-033-054
- Practice address
- 518 Arlington St
Rocky Mount, NC 27801-5657 - Phone
- (252) 446-2082
- NPI assigned
- Jan 22, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emotionally Disturbed Childrens' Residential Treatment Facility | 322D00000X | MHL-033-054 | NC | Primary |
Addresses
Primary practice location
518 Arlington St
Rocky Mount, NC 27801-5657
Mailing address
131 Bynum PL
Norlina, NC 27563-9139
Phone (252) 257-2307
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MHL-033-054 | NC | MD | Emotionally Disturbed Childrens' Residential Treatment Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200960000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200960000000",
"number": "1265619274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "131 BYNUM PL",
"city": "NORLINA",
"state": "NC",
"postal_code": "275639139",
"telephone_number": "252-257-2307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "518 ARLINGTON ST",
"city": "ROCKY MOUNT",
"state": "NC",
"postal_code": "278015657",
"telephone_number": "252-446-2082"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BYNUM",
"first_name": "MOORE",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-01-22",
"last_updated": "2008-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "322D00000X",
"taxonomy_group": "",
"desc": "Residential Treatment Facility, Emotionally Disturbed Children",
"state": "NC",
"license": "MHL-033-054",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rocky Mount, NC
- Holly Griffin Burkholder, PA-C
- Deborah Bullock Burnette, MA.ED, LPC, LCAS,CCS
- Elizabeth Dawn Burnette, FNP
- Kenya Chante Burton, LCSW-A
- Heather Butler, MEDCCC-SLP
- Kelli Marie Byrd, MSW, LCSWA
- Elia Xiomara Cabrera, PA-C
- Ana Leticia Calvio, NP-C
- Robyn Natalie Calvio
- Cambridge Behavioral Health Services
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 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.