NPIMap

Organization Active NPI

Carolina Outreach, LLC

  • Community/Behavioral Health Agency
  • Fayetteville, NC
National Provider Identifier
1548601743
Registry record updated Jul 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
3410049 Issued in NC
Legal business name
CAROLINA OUTREACH, LLC
Practice address
911 Hay St
Fayetteville, NC 28305-5313
Phone
(910) 826-3694
Fax
(910) 826-3695
NPI assigned
Jul 16, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2013

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

Authorized official

Name
Tim Brooks, LCSW
Title
Co-Director
Phone
(919) 251-9001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 3410049 NC Primary

Addresses

Primary practice location

911 Hay St
Fayetteville, NC 28305-5313

Mailing address

2670 Durham Chapel Hill Blvd
Durham, NC 27707-2829
Phone (919) 251-9001

Other identifiers 1

IdentifierTypeStateIssuer
8300219AMedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Carolina Outreach LLC19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1373932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373932800000",
    "number": "1548601743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2670 DURHAM CHAPEL HILL BLVD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277072829",
            "telephone_number": "919-251-9001",
            "fax_number": "919-251-9008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 HAY ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055313",
            "telephone_number": "910-826-3694",
            "fax_number": "910-826-3695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA OUTREACH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-16",
        "last_updated": "2013-07-16",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CO-DIRECTOR",
        "authorized_official_telephone_number": "919-251-9001",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "3410049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300219A",
            "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 Jul 16, 2013; 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.