NPIMap

Organization Active NPI

Country Pines Inc

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • La Grange, NC
National Provider Identifier
1497968762
Registry record updated Sep 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
MHL096117 Issued in NC
Legal business name
COUNTRY PINES INC
Practice address
2307 N Beston Rd
La Grange, NC 28551-8627
Phone
(919) 778-4009
Fax
(919) 778-4009
NPI assigned
May 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2007

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

Authorized official

Name
Mr. Kenneth Michael Sauls Sr., BS BUSINESS
Title
Vice President
Phone
(919) 778-4009

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL096117 NC Primary
Mental Illness Community Based Residential Treatment Facility 320800000X MHL096117 NC

Addresses

Primary practice location

2307 N Beston Rd
La Grange, NC 28551-8627

Mailing address

2307 N Beston Rd
La Grange, NC 28551-8627
Phone (919) 778-4009

Other identifiers 3

IdentifierTypeStateIssuer
7804027MedicaidNC
3409221OtherNCCAP
8301207OtherNCCOMM SUPPORT

Other names 1

  • Country Pines #1 Other name

National Provider Directory

National Provider Directory
Tax ID family
Country Pines 13 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.

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188864000000",
    "number": "1497968762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2307 N BESTON RD",
            "city": "LA GRANGE",
            "state": "NC",
            "postal_code": "285518627",
            "telephone_number": "919-778-4009",
            "fax_number": "919-778-4009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2307 N BESTON RD",
            "city": "LA GRANGE",
            "state": "NC",
            "postal_code": "285518627",
            "telephone_number": "919-778-4009",
            "fax_number": "919-778-4009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY PINES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2007-09-04",
        "status": "A",
        "authorized_official_last_name": "SAULS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "919-778-4009",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "BS BUSINESS"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL096117",
            "primary": true
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL096117",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804027",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAP",
            "identifier": "3409221",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMM SUPPORT",
            "identifier": "8301207",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Pines #1",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in La Grange, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2007; 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.