Coltrane'S Group Home

Primary specialty

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

License

MHL-041-620 Issued in NC

Legal business name

COLTRANE'S GROUP HOME

Practice address

3811 Repon St
Greensboro, NC 27407-5536

Phone

(336) 299-1419

NPI assigned

Apr 25, 2008

Organization subpart

No

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

Authorized official

Name

Lathay Coltrane

Title

Ceo

Phone

(336) 669-2819

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Coltranes Group Home3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Coltranes Group Home

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Greensboro, NC
  • NPI 1366594715
  NPD tax ID
• Coltranes Group Home

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Greensboro, NC
  • NPI 1750576997
  NPD tax ID

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

{
    "created_epoch": "1209081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209081600000",
    "number": "1437324902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 79113",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274179113",
            "telephone_number": "336-299-1419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3811 REPON ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274075536",
            "telephone_number": "336-299-1419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLTRANE'S GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-25",
        "last_updated": "2008-04-25",
        "status": "A",
        "authorized_official_last_name": "COLTRANE",
        "authorized_official_first_name": "LATHAY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "336-669-2819"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-041-620",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804354",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donna Medley Colson, COTA
• Kabrya Elizabeth Colson
• Colten Butler DMD PLLC
• Lathay Coltrane
• Teresa L Coltrane, RN
• Coltranes Group Home
• Coltranes Group Home
• Rachel Morgan Colvin
• Allison Brooke Combs, D.O.
• Kelsy Edward Combs, PHARMD

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Greensboro, NC
• Providers in Greensboro, 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 Apr 25, 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.

Verify at the official NPI Registry.