Quad County Group Homes for Emotionally Disturbed Children, Inc.

Primary specialty

Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X

License

MHL-085-002 Issued in NC

Legal business name

QUAD COUNTY GROUP HOMES FOR EMOTIONALLY DISTURBED CHILDREN, INC.

Doing business as

Serendipity House

Practice address

664 Spring St
Walnut Cove, NC 27052-6879

Phone

(336) 591-7234

Fax

(336) 591-8230

NPI assigned

Oct 17, 2006

Organization subpart

No

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

Authorized official

Name

Mr. P. Michael Hartwig, MSW

Title

Executive Director

Phone

(336) 591-7234

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Serendipity House Doing business as

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609957869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 508",
            "city": "WALNUT COVE",
            "state": "NC",
            "postal_code": "270520508",
            "telephone_number": "336-591-7234",
            "fax_number": "336-591-8230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "664 SPRING ST",
            "city": "WALNUT COVE",
            "state": "NC",
            "postal_code": "270526879",
            "telephone_number": "336-591-7234",
            "fax_number": "336-591-8230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUAD COUNTY GROUP HOMES FOR EMOTIONALLY DISTURBED CHILDREN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HARTWIG",
        "authorized_official_first_name": "P.",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "336-591-7234",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "NC",
            "license": "MHL-085-002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603055",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Serendipity House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Betty Presnell
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• James Doyle Richardson, RPH, BS
• Ridge Care Management, Inc.
• Amanda Lin Robertson
• Breanna Nicole Robertson, MS, LCAS-A

• Psychiatric Residential Treatment Facility in Walnut Cove, NC
• Providers in Walnut Cove, NC by specialty
• Psychiatric Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.