NPIMap

Organization Active NPI

Carter Clinic, PA

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Fayetteville, NC
National Provider Identifier
1386071835
Registry record updated Sep 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
CARTER CLINIC, PA
Practice address
235 Kinlaw Rd
Fayetteville, NC 28311-1431
Phone
(919) 848-0132
NPI assigned
Sep 30, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2013

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

Authorized official

Name
Myleme HarrisonNPI 1164477691
Title
President
Phone
(919) 848-0132

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X Primary

Addresses

Primary practice location

235 Kinlaw Rd
Fayetteville, NC 28311-1431

Mailing address

PO Box 99778
Raleigh, NC 27624-9778

Other identifiers 1

IdentifierTypeStateIssuer
N/AMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386071835. Details of each certification follow.

  • CCN 34G177 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 34G177

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
THE CARTER CLINIC RESIDENTIAL HOME
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Feb 8, 1991
Last certification
Mar 18, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
235 Kinlaw Road
Fayetteville, NC 28311

National Provider Directory

National Provider Directory
Tax ID family
Carter Clinic PA16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1380499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380499200000",
    "number": "1386071835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 99778",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276249778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 KINLAW RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283111431",
            "telephone_number": "919-848-0132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARTER CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-30",
        "last_updated": "2013-09-30",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "MYLEME",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-848-0132"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N/A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.