NPIMap

Organization Active NPI

Pembroke Center for Wellness, Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • Pembroke, NC
National Provider Identifier
1467726448
Registry record updated Jan 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
5000705 Issued in NC
Legal business name
PEMBROKE CENTER FOR WELLNESS, INC
Practice address
773 Old Main Rd
Pembroke, NC 28372-8753
Phone
(910) 775-9201
Fax
(910) 521-8540
NPI assigned
Mar 8, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2013

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

Authorized official

Name
Mrs. Ella Olehonna Lynch, FNP-C, PMHNP-BCNPI 1184611139
Title
President, Ceo
Phone
(910) 775-9201

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X C006439 NC
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X LMFT-1304 NC
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X 5000705 NC Primary

Addresses

Primary practice location

773 Old Main Rd
Pembroke, NC 28372-8753

Mailing address

773 Old Main Rd
Pembroke, NC 28372-8753
Phone (910) 775-9201

Other identifiers 1

IdentifierTypeStateIssuer
5917311MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Pembroke Center for Wellness2 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.

Locations

773 Old Main Rd
Pembroke, NC 28372
Phone (910) 775-9201

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1331164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358467200000",
    "number": "1467726448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "773 OLD MAIN RD",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283728753",
            "telephone_number": "910-775-9201",
            "fax_number": "910-521-8540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "773 OLD MAIN RD",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283728753",
            "telephone_number": "910-775-9201",
            "fax_number": "910-521-8540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEMBROKE CENTER FOR WELLNESS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-08",
        "last_updated": "2013-01-18",
        "status": "A",
        "authorized_official_last_name": "LYNCH",
        "authorized_official_first_name": "ELLA",
        "authorized_official_middle_name": "OLEHONNA",
        "authorized_official_title_or_position": "PRESIDENT, CEO",
        "authorized_official_telephone_number": "910-775-9201",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP-C, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C006439",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "NC",
            "license": "LMFT-1304",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "5000705",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5917311",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2013; 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.