NPIMap

Organization Active NPI

Extended Reach Day Treatment for Children and Adolescents, LLC

  • Community/Behavioral Health Agency
  • Fayetteville, NC
National Provider Identifier
1487829248
Registry record updated May 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
EXTENDED REACH DAY TREATMENT FOR CHILDREN AND ADOLESCENTS, LLC
Practice address
2716 Custer Ave
Fayetteville, NC 28312-7814
Phone
(910) 484-0095
Fax
(919) 238-7238
NPI assigned
Apr 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2010

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

Authorized official

Name
Andrea Monique Boatman-Hall
Title
C.E.O
Phone
(910) 229-8256

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

2716 Custer Ave
Fayetteville, NC 28312-7814

Mailing address

2716 Custer Ave
Fayetteville, NC 28312-7814
Phone (910) 484-0095

Other identifiers 2

IdentifierTypeStateIssuer
8302339MedicaidNC
6006927MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Extended Reach Day Treatment for Children Adolescents LLC3 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.

Locations

2716 Custer Ave
Fayetteville, NC 28312
Phone (910) 484-0095

NPI Registry JSON

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

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274918400000",
    "number": "1487829248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2716 CUSTER AVE",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283127814",
            "telephone_number": "910-484-0095",
            "fax_number": "919-238-7238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2716 CUSTER AVE",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283127814",
            "telephone_number": "910-484-0095",
            "fax_number": "919-238-7238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDED REACH DAY TREATMENT FOR CHILDREN AND ADOLESCENTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-23",
        "last_updated": "2010-05-27",
        "status": "A",
        "authorized_official_last_name": "BOATMAN-HALL",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "MONIQUE",
        "authorized_official_title_or_position": "C.E.O",
        "authorized_official_telephone_number": "910-229-8256"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8302339",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006927",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2010; 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.