J4 Stability & Safe Haven LLC

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Legal business name

J4 STABILITY & SAFE HAVEN LLC

Practice address

1308 N Independence St
Kinston, NC 28501-2908

Phone

(336) 749-5267

NPI assigned

May 17, 2023

Organization subpart

No

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

Authorized official

Name

Shadae T Williams, LCSWA LCASA CADCNPI 1619459864

Title

Owner/ Ceo

Phone

(336) 749-5267

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shadae T Williams

  • Clinical Social Worker
  • Winston Salem, NC
  • NPI 1619459864
  NPD Authorized official

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

{
    "created_epoch": "1684281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684281600000",
    "number": "1467143883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6201 MAURICE CIR",
            "city": "RURAL HALL",
            "state": "NC",
            "postal_code": "270459734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1308 N INDEPENDENCE ST",
            "city": "KINSTON",
            "state": "NC",
            "postal_code": "285012908",
            "telephone_number": "336-749-5267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J4 STABILITY & SAFE HAVEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-17",
        "last_updated": "2023-05-17",
        "certification_date": "2023-05-17",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "SHADAE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER/ CEO",
        "authorized_official_telephone_number": "336-749-5267",
        "authorized_official_credential": "LCSWA LCASA CADC"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Emotionally Disturbed Childrens' Residential Treatment Facility in Kinston, NC
• Providers in Kinston, NC by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2023; 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.