Fayetteville Street Community Living Home

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

MHL032445 Issued in NC

Legal business name

FAYETTEVILLE STREET COMMUNITY LIVING HOME

Practice address

111 N Maple St
Durham, NC 27703-3021

Phone

(919) 519-0016

Fax

(919) 596-0645

NPI assigned

Jul 2, 2008

Last updated

Dec 12, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robin Artis Williams

Title

Administor

Phone

(919) 519-0016

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386806400000",
    "number": "1295998029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 N MAPLE ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277033021",
            "telephone_number": "919-519-0016",
            "fax_number": "919-596-0645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N MAPLE ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277033021",
            "telephone_number": "919-519-0016",
            "fax_number": "919-596-0645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE STREET COMMUNITY LIVING HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-02",
        "last_updated": "2013-12-12",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_middle_name": "ARTIS",
        "authorized_official_title_or_position": "ADMINISTOR",
        "authorized_official_telephone_number": "919-519-0016"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL032445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nakisha Monique Faust
• Jenny L. Favret, RD
• Adam Abedel Ellah Fawaz, MD
• Ashley Fay
• Lauren Lindigrin Fay, M.S., CCC-SLP
• Heather Fayhee, FNP
• David Fear
• Fearless Foundations Counseling, PLLC
• Phillip Febbo, M.D.
• Teresa E Fecteau, PHD

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Durham, NC
• Providers in Durham, NC by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.