NPIMap

Organization Active NPI

Youth Enrichment Group Home, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Greensboro, NC
National Provider Identifier
1528119096
Registry record updated Jun 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
YOUTH ENRICHMENT GROUP HOME, INC.
Doing business as
Wynmere Place
Practice address
203 Hammond Dr
Greensboro, NC 27406-8149
Phone
(336) 389-1913
Fax
(877) 846-8962
NPI assigned
Jan 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2019

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

Authorized official

Name
Mrs. Devolia Pratt Sweet
Title
Assistant Director
Phone
(336) 382-6658

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Primary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL-041-658 NC

Addresses

Primary practice location

203 Hammond Dr
Greensboro, NC 27406-8149

Mailing address

4299 Harbor Ridge Dr
Greensboro, NC 27406-8576
Phone (336) 382-6658

Other identifiers 1

IdentifierTypeStateIssuer
6603440MedicaidNC

Other names 1

  • Wynmere Place Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Youth Enrichment Group Home Inc6 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": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559606400000",
    "number": "1528119096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4299 HARBOR RIDGE DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274068576",
            "telephone_number": "336-382-6658",
            "fax_number": "877-846-8962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 HAMMOND DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274068149",
            "telephone_number": "336-389-1913",
            "fax_number": "877-846-8962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTH ENRICHMENT GROUP HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2019-06-04",
        "status": "A",
        "authorized_official_last_name": "SWEET",
        "authorized_official_first_name": "DEVOLIA",
        "authorized_official_middle_name": "PRATT",
        "authorized_official_title_or_position": "ASSISTANT DIRECTOR",
        "authorized_official_telephone_number": "336-382-6658",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-041-658",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603440",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wynmere Place",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wynmere Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2019; 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.