NPIMap

Organization Active NPI

Our Fathers Place Inc

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Statesville, NC
National Provider Identifier
1346303187
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
MHL049093 Issued in NC
Legal business name
OUR FATHERS PLACE INC
Practice address
413 Stockton Street
Statesville, NC 28677-5325
Phone
(704) 872-0313
Fax
(704) 872-7787
NPI assigned
Dec 19, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. James Russell Linton, MED
Title
Chief Executive Officer
Phone
(704) 684-0197

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL049093 NC Primary

Addresses

Primary practice location

413 Stockton Street
Statesville, NC 28677-5325

Mailing address

256 East Broad Street
Statesville, NC 28677-5325
Phone (704) 872-0313

Other identifiers 1

IdentifierTypeStateIssuer
6603681MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Our Fathers Place Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

256 E Broad St
Statesville, NC 28677
Phone (704) 872-0313

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1346303187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "256 EAST BROAD STREET",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286775325",
            "telephone_number": "704-872-0313",
            "fax_number": "704-872-7787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 STOCKTON STREET",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286775325",
            "telephone_number": "704-872-0313",
            "fax_number": "704-872-7787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUR FATHERS PLACE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LINTON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "704-684-0197",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MED"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL049093",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603681",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.