NPIMap

Organization Active NPI

O'Berry Neuro-Medical Treatment Center

  • Intellectual Disabilities Intermediate Care Facility
  • Goldsboro, NC
National Provider Identifier
1508902032
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
O'BERRY NEURO-MEDICAL TREATMENT CENTER
Practice address
400 Old Smithfield Road
Goldsboro, NC 27530
Phone
(919) 581-4000
Fax
(919) 581-4038
NPI assigned
Jan 30, 2007
Last updated
Oct 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Authorized official

Name
Karen Burkes
Title
Division Director
Phone
(919) 855-4700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

400 Old Smithfield Road
Goldsboro, NC 27530

Mailing address

400 Old Smithfield Road
Goldsboro, NC 27530-8464
Phone (919) 581-4000

Other identifiers 1

IdentifierTypeStateIssuer
3406028MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508902032. Details of each certification follow.

  • CCN 34G004 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 34G004

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
O'BERRY NEURO-MEDICAL TREATMENT CENTER
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Mar 31, 1974
Last certification
May 2, 2023
Beds
485
Ownership / control type
State
Most recent change of ownership
Aug 28, 2018
Facility address
400 Old Smithfield Rd
Goldsboro, NC 27530

National Provider Directory

National Provider Directory
Tax ID family
O'Berry Neuro-Medical Treatment Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729123200000",
    "number": "1508902032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 OLD SMITHFIELD ROAD",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275308464",
            "telephone_number": "919-581-4000",
            "fax_number": "919-581-4038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 OLD SMITHFIELD ROAD",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "27530",
            "telephone_number": "919-581-4000",
            "fax_number": "919-581-4038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "O'BERRY NEURO-MEDICAL TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A",
        "authorized_official_last_name": "BURKES",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "DIVISION DIRECTOR",
        "authorized_official_telephone_number": "919-855-4700"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406028",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goldsboro, NC

Sources for this page

Verify at the official NPI Registry.