NPIMap

Organization Active NPI

Our Fathers Place Inc

  • Mental Illness Community Based Residential Treatment Facility
  • Statesville, NC
National Provider Identifier
1275637423
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
OUR FATHERS PLACE INC
Practice address
256 East Broad Street
Statesville, NC 28677
Phone
(704) 872-0313
Fax
(704) 872-7787
NPI assigned
Sep 9, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Mr. James Russell Linton, MED
Title
Chief Executive Officer
Phone
(704) 684-0197

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X NC Primary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X NC

Addresses

Primary practice location

256 East Broad Street
Statesville, NC 28677

Mailing address

256 East Broad Street
Statesville, NC 28677
Phone (704) 872-0313

Other identifiers 2

IdentifierTypeStateIssuer
6603681MedicaidNC
6603748MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Our Fathers Place Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1157760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1275637423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "256 EAST BROAD STREET",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "28677",
            "telephone_number": "704-872-0313",
            "fax_number": "704-872-7787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "256 EAST BROAD STREET",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "28677",
            "telephone_number": "704-872-0313",
            "fax_number": "704-872-7787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUR FATHERS PLACE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-09",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "LINTON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "704-684-0197",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MED"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": null,
            "primary": true
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603681",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603748",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.