Prosperous Living Adolescent Center, Inc

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

PROSPEROUS LIVING ADOLESCENT CENTER, INC

Practice address

3412 Lake Woodard Dr
Raleigh, NC 27604-3854

Phone

(919) 231-0025

NPI assigned

Jan 4, 2009

Organization subpart

No

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

Authorized official

Name

Mrs. Mildred M Brown

Title

Program Director

Phone

(919) 361-0208

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1231027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483056000000",
    "number": "1295971844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3412 LAKE WOODARD DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276043854",
            "telephone_number": "919-231-0025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3412 LAKE WOODARD DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276043854",
            "telephone_number": "919-231-0025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPEROUS LIVING ADOLESCENT CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-04",
        "last_updated": "2016-12-30",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "MILDRED",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "919-361-0208",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Illness Community Based Residential Treatment Facility in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Mental Illness Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2016; 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.