NPIMap

Organization Active NPI

Peaceful House III

  • Adult Care Home Facility
  • Durham, NC
National Provider Identifier
1356546113
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
Legal business name
PEACEFUL HOUSE III
Practice address
2724 Marlin Dr
Durham, NC 27703-4354
Phone
(919) 641-7981
Fax
(919) 957-4681
NPI assigned
Jun 20, 2007
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
Carley Y Jegbadai, RN
Title
Administrator
Phone
(919) 790-1953

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X Primary

Addresses

Primary practice location

2724 Marlin Dr
Durham, NC 27703-4354

Mailing address

2724 Marlin Dr
Durham, NC 27703-4354
Phone (919) 641-7981

Other identifiers 1

IdentifierTypeStateIssuer
7805386MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Support Staff Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356546113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2724 MARLIN DR",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277034354",
            "telephone_number": "919-641-7981",
            "fax_number": "919-957-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2724 MARLIN DR",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277034354",
            "telephone_number": "919-641-7981",
            "fax_number": "919-957-4681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACEFUL HOUSE III",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JEGBADAI",
        "authorized_official_first_name": "CARLEY",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "919-790-1953",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805386",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, 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.