Active NPI
Mildred Harris, ADMINISTRATOR
- Adult Care Home Facility
- Beaufort, NC
National Provider Identifier
1366635120
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Care Home Facility
- License
- FCL016-013
- Practice address
- 834 Hwy 101
Beaufort, NC 28516-7717 - Phone
- (252) 728-6525
- NPI assigned
- Aug 23, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Care Home Facility | 311ZA0620X | FCL016-013 | NC | Primary |
Addresses
Primary practice location
834 Hwy 101
Beaufort, NC 28516-7717
Mailing address
834 Hwy 101
Beaufort, NC 28516-7717
Phone (252) 728-7490
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7803990 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| FCL016-013 | NC | MD | Adult Care Home Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214179200000",
"number": "1366635120",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "834 HWY 101",
"city": "BEAUFORT",
"state": "NC",
"postal_code": "285167717",
"telephone_number": "252-728-7490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "834 HWY 101",
"city": "BEAUFORT",
"state": "NC",
"postal_code": "285167717",
"telephone_number": "252-728-6525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "MILDRED",
"name_prefix": "Mrs.",
"credential": "ADMINISTRATOR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-08-23",
"last_updated": "2008-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "311ZA0620X",
"taxonomy_group": "",
"desc": "Custodial Care Facility, Adult Care Home",
"state": "NC",
"license": "FCL016-013",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7803990",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaufort, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.