NPIMap

Organization Active NPI

Redesigning Life of N.C.,LL

  • Adult Mental Health Clinic/Center
  • Wilson, NC
National Provider Identifier
1366729048
Registry record updated Nov 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
MHL-098-173 Issued in NC
Legal business name
REDESIGNING LIFE OF N.C.,LL
Practice address
806 Tarboro St W
Suite a
Wilson, NC 27893-4771
Phone
(252) 363-4122
Fax
(252) 296-0033
NPI assigned
Nov 9, 2011
Organization subpart
Yes
Parent organization
HARVEST CARE OF N.C., LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 9, 2011

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

Authorized official

Name
Chandra Revis Pegues
Title
Director/Owner
Phone
(252) 363-4122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X MHL-098-173 NC Primary

Addresses

Primary practice location

806 Tarboro St W
Suite a
Wilson, NC 27893-4771

Mailing address

PO Box 683
Wilson, NC 27894-0683
Phone (252) 363-4122

National Provider Directory

National Provider Directory
Tax ID family
Redesigning Life of NCLL3 organizations share this tax ID, including this one
Part of
Redesigning Life of NCLL

Other organizations with this tax ID 2

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

Locations

806 Tarboro St W
Ste A
Wilson, NC 27893
Phone (252) 363-4122

NPI Registry JSON

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

{
    "created_epoch": "1320796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320796800000",
    "number": "1366729048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 683",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278940683",
            "telephone_number": "252-363-4122",
            "fax_number": "252-296-0033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 TARBORO ST W",
            "address_2": "SUITE A",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278934771",
            "telephone_number": "252-363-4122",
            "fax_number": "252-296-0033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDESIGNING LIFE OF N.C.,LL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HARVEST CARE OF N.C., LLC",
        "enumeration_date": "2011-11-09",
        "last_updated": "2011-11-09",
        "status": "A",
        "authorized_official_last_name": "PEGUES",
        "authorized_official_first_name": "CHANDRA",
        "authorized_official_middle_name": "REVIS",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "252-363-4122"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NC",
            "license": "MHL-098-173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilson, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2011; 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.