NPIMap

Organization Active NPI

Potter'S House Outreach Corporation

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Raeford, NC
National Provider Identifier
1568622009
Registry record updated Jun 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
MHL047074 Issued in NC
Legal business name
POTTER'S HOUSE OUTREACH CORPORATION
Practice address
105 Harvest LN
Raeford, NC 28376-6516
Phone
(910) 904-5791
Fax
(910) 904-6791
NPI assigned
Jun 9, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2008

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

Authorized official

Name
Mr. Vincent Terrell Robinson
Title
Ceo
Phone
(910) 904-5791

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL047074 NC Primary

Addresses

Primary practice location

105 Harvest LN
Raeford, NC 28376-6516

Mailing address

PO Box 26073
Fayetteville, NC 28314-5017
Phone (910) 904-5791

National Provider Directory

National Provider Directory
Tax ID family
Potter'S House Outreach Corporation4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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": "1212969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212969600000",
    "number": "1568622009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26073",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283145017",
            "telephone_number": "910-904-5791",
            "fax_number": "910-904-6791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 HARVEST LN",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283766516",
            "telephone_number": "910-904-5791",
            "fax_number": "910-904-6791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTTER'S HOUSE OUTREACH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-09",
        "last_updated": "2008-06-09",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "VINCENT",
        "authorized_official_middle_name": "TERRELL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-904-5791",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL047074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raeford, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; 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.