Central Care Division, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

MHL-079-083 Issued in NC

Legal business name

CENTRAL CARE DIVISION, LLC

Practice address

722 Miles Street
Eden, NC 27288-2822

Phone

(336) 635-2000

Fax

(336) 635-2003

NPI assigned

Jan 9, 2007

Last updated

Sep 13, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Edward F. Staples

Title

Owner

Phone

(336) 635-2000

Specialties & licenses 3

Addresses

Other identifiers 5

Tax ID family

Central Care Division LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Central Care Division, LLC

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Eden, NC
  • NPI 1346415809
  NPD tax ID

Locations

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284336000000",
    "number": "1376692509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 N. BRIDGE ST",
            "city": "EDEN",
            "state": "NC",
            "postal_code": "272885647",
            "telephone_number": "336-635-2000",
            "fax_number": "336-635-2003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "722 MILES STREET",
            "city": "EDEN",
            "state": "NC",
            "postal_code": "272882822",
            "telephone_number": "336-635-2000",
            "fax_number": "336-635-2003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL CARE DIVISION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2010-09-13",
        "status": "A",
        "authorized_official_last_name": "STAPLES",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-635-2000"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-079-080",
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-079-083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301618",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603595",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603985",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301618B",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3418285",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin Jones Carroll, PA-C
• Kelsey Carter
• Angel G Cassell, HOME CARE AID
• Reginald Cathey, MD
• Central Care Division, LLC
• Central State of the Carolinas, Inc.
• Ashly Chadwell, DPT
• Challenges Group Homes, Inc (Connections Behavioral Health Services)
• Challenges Group Homes, Inc. (Connections Behavioral Health Services)
• Erik D Christensen, CPO

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Eden, NC
• Providers in Eden, NC by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2010; 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.