NPIMap

Organization Active NPI

Professional Group Living, LLC

  • Community/Behavioral Health Agency
  • Henderson, NC
National Provider Identifier
1265620421
Registry record updated Oct 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
PROFESSIONAL GROUP LIVING, LLC
Practice address
1775 Graham Ave
Suite 104
Henderson, NC 27536-5948
Phone
(919) 475-5845
NPI assigned
Oct 11, 2007
Last updated
Oct 11, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2007

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

Authorized official

Name
Mrs. Natalka A Lock Massey
Title
Executive Director
Phone
(919) 475-5845

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1775 Graham Ave
Suite 104
Henderson, NC 27536-5948

Mailing address

1775 Graham Ave
Suite 104
Henderson, NC 27536-5948
Phone (919) 475-5845

Other identifiers 1

IdentifierTypeStateIssuer
8302074MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Professional Group Living LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

1775 Graham Ave
Ste 104
Henderson, NC 27536
Phone (919) 475-5845

NPI Registry JSON

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

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192060800000",
    "number": "1265620421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1775 GRAHAM AVE",
            "address_2": "SUITE 104",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275365948",
            "telephone_number": "919-475-5845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 GRAHAM AVE",
            "address_2": "SUITE 104",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275365948",
            "telephone_number": "919-475-5845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL GROUP LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-11",
        "last_updated": "2007-10-11",
        "status": "A",
        "authorized_official_last_name": "LOCK MASSEY",
        "authorized_official_first_name": "NATALKA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "919-475-5845",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8302074",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 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.