NPIMap

Organization Active NPI

Centerstone of Tennesse Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fayetteville, NC
National Provider Identifier
1609482439
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
CENTERSTONE OF TENNESSE INC.
Practice address
3505 Village Dr
Fayetteville, NC 28304-4513
Phone
(615) 463-6669
Fax
(615) 653-6506
NPI assigned
Sep 17, 2020
Last updated
Sep 17, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
CENTERSTONE OF TENNESSE INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

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

Authorized official

Name
Karen Lynette Keene
Title
Security Officer, It Technology Sup
Phone
(615) 463-6523

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

3505 Village Dr
Fayetteville, NC 28304-4513

Mailing address

PO Box 197520
Nashville, TN 37219-7520
Phone (615) 463-6669

Other names 1

  • Centerstone Fayettville NC Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210219001917 NC Part B Supplier - Clinic/Group Practice 9739088113 Receives reassigned benefits from 20 practitioners
Practice locations: Fayetteville, NC

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Centerstone Community M27 organizations share this tax ID, including this one
Part of
Centerstone Community M

Other organizations with this tax ID 26

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

View all 26

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1600300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600300800000",
    "number": "1609482439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 197520",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372197520",
            "telephone_number": "615-463-6669",
            "fax_number": "615-653-6506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 VILLAGE DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044513",
            "telephone_number": "615-463-6669",
            "fax_number": "615-653-6506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERSTONE OF TENNESSE INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTERSTONE OF TENNESSE INC.",
        "enumeration_date": "2020-09-17",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A",
        "authorized_official_last_name": "KEENE",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "LYNETTE",
        "authorized_official_title_or_position": "SECURITY OFFICER, IT TECHNOLOGY SUP",
        "authorized_official_telephone_number": "615-463-6523"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centerstone Fayettville NC Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Sep 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.