Active NPI
Linda Elizabeth Gibson
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Jacksonville, NC
National Provider Identifier
1265693584
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- License
- MHL-067-026
- Practice address
- 180 Coastal LN
Jacksonville, NC 28546-6761 - Phone
- (910) 455-6724
- Fax
- (910) 346-5489
- NPI assigned
- Jun 19, 2008
- Last updated
- Jun 19, 2015
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | MHL-067-026 | NC | Primary |
Addresses
Primary practice location
180 Coastal LN
Jacksonville, NC 28546-6761
Mailing address
180 Coastal LN
Jacksonville, NC 28546-6761
Phone (910) 455-6724
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3408956 | Medicaid | NC |
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-067-026 | NC | MD | Intellectual and/or Developmental Disabilities Residential Treatment Facility |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- Jacksonville, NC
- NPI 1124184452
-
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Jacksonville, NC
- NPI 1043376387
-
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Jacksonville, NC
- NPI 1760549703
-
- Developmental Disabilities Clinic/Center
- Jacksonville, NC
- NPI 1316003668
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434672000000",
"number": "1265693584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 COASTAL LN",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "285466761",
"telephone_number": "910-455-6724",
"fax_number": "910-346-5489"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "180 COASTAL LN",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "285466761",
"telephone_number": "910-455-6724",
"fax_number": "910-346-5489"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "LINDA",
"middle_name": "ELIZABETH",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-06-19",
"last_updated": "2015-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "320600000X",
"taxonomy_group": "",
"desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": "NC",
"license": "MHL-067-026",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3408956",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.