Christus Advocacy Council

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

MHL-078-209 Issued in NC

Legal business name

CHRISTUS ADVOCACY COUNCIL

Doing business as

Poplar House

Practice address

53 Poplar Street
Parkton, NC 28371-0640

Phone

(910) 858-0033

NPI assigned

Feb 19, 2009

Last updated

Feb 19, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Alvin Gerard Jordan Sr.

Title

Volunteer

Phone

(610) 647-2530

Specialties & licenses 1

Addresses

Other names 1

• Poplar House Doing business as

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

{
    "created_epoch": "1235001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235001600000",
    "number": "1568601227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 640",
            "city": "PARKTON",
            "state": "NC",
            "postal_code": "283710640",
            "telephone_number": "910-735-2988",
            "fax_number": "910-735-2987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 POPLAR STREET",
            "city": "PARKTON",
            "state": "NC",
            "postal_code": "283710640",
            "telephone_number": "910-858-0033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTUS ADVOCACY COUNCIL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-19",
        "last_updated": "2009-02-19",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "ALVIN",
        "authorized_official_middle_name": "GERARD",
        "authorized_official_title_or_position": "VOLUNTEER",
        "authorized_official_telephone_number": "610-647-2530",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-078-209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Poplar House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Darrelle E Green (Green Manor Rest Home)
• Brittany Lynn Davis, CHHC, CHN
• Agnes Marie Dinwiddie

• Emotionally Disturbed Childrens' Residential Treatment Facility in Parkton, NC
• Providers in Parkton, NC by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2009; 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.