It Takes a Village Residential Care LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

IT TAKES A VILLAGE RESIDENTIAL CARE LLC

Practice address

5008 Butterfield Dr
Winston Salem, NC 27105-3344

Phone

(336) 608-2819

NPI assigned

Feb 17, 2020

Organization subpart

No

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

Authorized official

Name

Chaquille Jackson

Title

Ceo

Phone

(336) 608-2819

Specialties & licenses 5

Addresses

Other identifiers 1

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

{
    "created_epoch": "1581897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581897600000",
    "number": "1407489529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5008 BUTTERFIELD DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271053344",
            "telephone_number": "336-608-2819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5008 BUTTERFIELD DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271053344",
            "telephone_number": "336-608-2819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IT TAKES A VILLAGE RESIDENTIAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-17",
        "last_updated": "2020-02-17",
        "certification_date": "2020-02-17",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "CHAQUILLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "336-608-2819"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NA",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fatima Zahra Islam
• Natsha Islar
• Alexandra Rhea Flowe Isley, DNP, CRNA
• Core'Darius Lamarquis Islove, PHARMD
• Timothy H Istock, OD
• Kateryna Ivanets
• Lauren Ivanoski, OD
• Nathaniel Nicholas Ivers, PH.D., LPC, NCC
• Thomas Steven Ivester, MD
• Holly Britt Ivey, M.D.

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2020; 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.