Organization Active NPI

Woodbridge Alternative, Inc

Community/Behavioral Health Agency
Fayetteville, NC

National Provider Identifier

1295874527

Registry record updated Apr 24, 2009

On this page

Key facts
NPPES NPI Registry
National Provider Directory
NPI Registry JSON
Other providers in Fayetteville, NC
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name: WOODBRIDGE ALTERNATIVE, INC
Practice address: 1480 Pamalee Dr
Fayetteville, NC 28303-3928
Phone: (910) 488-9570
Fax: (910) 822-0111
NPI assigned: Feb 5, 2007
Organization subpart: No

NPPES NPI Registry

Updated by the provider on Apr 24, 2009

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

Authorized official

Name: Mr. Leon Robinson
Title: Vice-President
Phone: (910) 488-9570

Specialties & licenses 15

Specialty (taxonomy)	Code	License	State	Primary
Community/Behavioral Health Agency	251S00000X			Primary
Mental Illness Community Based Residential Treatment Facility	320800000X
Emotionally Disturbed Childrens' Residential Treatment Facility	322D00000X	MHL026718	NC
Emotionally Disturbed Childrens' Residential Treatment Facility	322D00000X	MHL026705	NC
Emotionally Disturbed Childrens' Residential Treatment Facility	322D00000X	MHL026680	NC
Emotionally Disturbed Childrens' Residential Treatment Facility	322D00000X	MHL065161	NC
Emotionally Disturbed Childrens' Residential Treatment Facility	322D00000X	MHL065155	NC
Emotionally Disturbed Childrens' Residential Treatment Facility	322D00000X	MHL026477	NC
Emotionally Disturbed Childrens' Residential Treatment Facility	322D00000X	MHL026464	NC
Emotionally Disturbed Childrens' Residential Treatment Facility	322D00000X	MHL026707	NC
Emotionally Disturbed Childrens' Residential Treatment Facility	322D00000X	MHL026454	NC
Emotionally Disturbed Childrens' Residential Treatment Facility	322D00000X	MHL009019	NC
Emotionally Disturbed Childrens' Residential Treatment Facility	322D00000X	MHL026557	NC
Emotionally Disturbed Childrens' Residential Treatment Facility	322D00000X	MHL026618	NC
Emotionally Disturbed Childrens' Residential Treatment Facility	322D00000X	MHL024052	NC

Addresses

Primary practice location

1480 Pamalee Dr
Fayetteville, NC 28303-3928

Mailing address

1480 Pamalee Driive
Fayetteville, NC 28303-3928
Phone (910) 488-9570

Other identifiers 19

Identifier	Type	State
6603588	Medicaid	NC
6603284	Medicaid	NC
6603733	Medicaid	NC
6603283	Medicaid	NC
8301341B	Medicaid	NC
6005215	Medicaid	NC
6005216	Medicaid	NC
6603044	Medicaid	NC
6603046	Medicaid	NC
6603282	Medicaid	NC
6603589	Medicaid	NC
8301341H	Medicaid	NC
6603603	Medicaid	NC
8301341G	Medicaid	NC
6603045	Medicaid	NC
6603136	Medicaid	NC
6603233	Medicaid	NC
6603325	Medicaid	NC
8301341	Medicaid	NC

National Provider Directory

Tax ID family: Woodbridge Alternative Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Woodbridge Alternative Inc
- Psychiatric/Mental Health Nurse Practitioner
- Raeford, NC
- NPI 1649506957
NPD tax ID

Locations

1480 Pamalee Dr
Fayetteville, NC 28303
Phone (910) 304-7866

NPI Registry JSON

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240531200000",
    "number": "1295874527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1480 PAMALEE DRIIVE",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283033928",
            "telephone_number": "910-488-9570",
            "fax_number": "910-822-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1480 PAMALEE DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283033928",
            "telephone_number": "910-488-9570",
            "fax_number": "910-822-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODBRIDGE ALTERNATIVE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2009-04-24",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "LEON",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "910-488-9570",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL026718",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL026705",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL026680",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL065161",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL065155",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL026477",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL026464",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL026707",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL026454",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL009019",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL026557",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL026618",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL024052",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603588",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603284",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603733",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603283",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301341B",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005215",
            "state": "NC"
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        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005216",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603044",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603046",
            "state": "NC"
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        {
            "code": "05",
            "desc": "MEDICAID",
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            "state": "NC"
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        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603589",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301341H",
            "state": "NC"
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        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
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            "state": "NC"
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        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301341G",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603045",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603136",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603233",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603325",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301341",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2009; 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.