Linda Shorts Home

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

License

MHL067026 Issued in NC

Legal business name

LINDA SHORTS HOME

Practice address

106 Grantham LN
Jacksonville, NC 28546-8150

Phone

(910) 455-4480

NPI assigned

Dec 29, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Linda E Gibson

Title

Director

Phone

(910) 455-6724

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435104000000",
    "number": "1316003668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 COASTAL LN",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466761",
            "telephone_number": "910-455-6724",
            "fax_number": "910-346-5489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 GRANTHAM LN",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285468150",
            "telephone_number": "910-455-4480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINDA SHORTS HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2015-06-24",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "910-455-6724",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "NC",
            "license": "MHL067026",
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL067026",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3408956",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Developmental Disabilities Clinic/Center in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Developmental Disabilities Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2015; 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.