NPIMap

Organization Active NPI

Professional Group Living, LLC

  • Community/Behavioral Health Agency
  • Goldsboro, NC
National Provider Identifier
1356582472
Registry record updated Mar 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
8109498 Issued in NC
Legal business name
PROFESSIONAL GROUP LIVING, LLC
Practice address
122 S Center St
Goldsboro, NC 27530-4829
Phone
(919) 735-2211
Fax
(919) 735-2277
NPI assigned
Mar 19, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2009

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

Authorized official

Name
Llewellyn Hicks
Title
Director
Phone
(919) 475-6124

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 8109498 NC
Community/Behavioral Health Agency 251S00000X 8109498 NC Primary

Addresses

Primary practice location

122 S Center St
Goldsboro, NC 27530-4829

Mailing address

510 Simmons St
Durham, NC 27701-4334
Phone (919) 688-0818

National Provider Directory

National Provider Directory
Tax ID family
Professional Group Living LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

510 Simmons St
Durham, NC 27701
Phone (919) 688-0818

NPI Registry JSON

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

{
    "created_epoch": "1237420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237420800000",
    "number": "1356582472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 SIMMONS ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277014334",
            "telephone_number": "919-688-0818",
            "fax_number": "919-688-0918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 S CENTER ST",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275304829",
            "telephone_number": "919-735-2211",
            "fax_number": "919-735-2277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL GROUP LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-19",
        "last_updated": "2009-03-19",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "LLEWELLYN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "919-475-6124"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NC",
            "license": "8109498",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "8109498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goldsboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2009; 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.