NPIMap

Organization Active NPI

Dutchess One

  • Mental Illness Community Based Residential Treatment Facility
  • Cary, NC
National Provider Identifier
1285931139
Registry record updated Feb 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
MHL-092-785 Issued in NC
Legal business name
DUTCHESS ONE
Practice address
1613 Burnley Dr
Cary, NC 27511-5004
Phone
(919) 521-8112
NPI assigned
Feb 11, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2011

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

Authorized official

Name
Mr. Demetrius Tiller
Title
Owner
Phone
(919) 521-8112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X MHL-092-785 NC Primary

Addresses

Primary practice location

1613 Burnley Dr
Cary, NC 27511-5004

Mailing address

1613 Burnley Dr
Cary, NC 27511-5004
Phone (919) 521-8112

National Provider Directory

National Provider Directory
Tax ID family
Dutchess II3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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": "1297382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297382400000",
    "number": "1285931139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1613 BURNLEY DR",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275115004",
            "telephone_number": "919-521-8112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1613 BURNLEY DR",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275115004",
            "telephone_number": "919-521-8112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUTCHESS ONE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-11",
        "last_updated": "2011-02-11",
        "status": "A",
        "authorized_official_last_name": "TILLER",
        "authorized_official_first_name": "DEMETRIUS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-521-8112",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL-092-785",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cary, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2011; 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.