Potterhouse Sanctuary Liberation

Primary specialty

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

License

MHL029640 Issued in NC

Legal business name

POTTERHOUSE SANCTUARY LIBERATION

Practice address

2805 Auburn Knightdale Rd
Raleigh, NC 27610-9712

Phone

(919) 217-9119

Fax

(919) 217-9118

NPI assigned

Jan 5, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Rosa L Moore

Title

President

Phone

(973) 223-4511

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244764800000",
    "number": "1487701868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7344 BERKSHIRE DOWNS DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276165636",
            "telephone_number": "919-217-9119",
            "fax_number": "919-217-9118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2805 AUBURN KNIGHTDALE RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276109712",
            "telephone_number": "919-217-9119",
            "fax_number": "919-217-9118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTTERHOUSE SANCTUARY LIBERATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2009-06-12",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "ROSA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "973-223-4511",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL029640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abigail Potter, PTA
• Kimberly Potter
• Lexi Potter, LCSWA
• Margaret Faye Potter, PA-C
• Michael L. Potter
• Brianna Nicole Potts
• Jasmine Maria Potts, LPC
• Margaret Mackey Potts, NP
• Shelby Gaile Potts, M.S. CCC-SLP
• Tamera Renee Pou

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Raleigh, NC
• Providers in Raleigh, 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 Jun 12, 2009; 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.