Rose of Sharon Adolescent Treatment Home II

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

051153 Issued in NC

Legal business name

ROSE OF SHARON ADOLESCENT TREATMENT HOME II

Practice address

2885 Bennington Dr
Clayton, NC 27520-5971

Phone

(919) 553-3383

Fax

(919) 550-2648

NPI assigned

Feb 21, 2007

Last updated

Jun 2, 2009By the provider in NPPES

Organization subpart

Yes

Parent organization

ROSE OF SHARON ADOLESCENT TREATMENT HOMEAs reported in NPPES

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

Authorized official

Name

Mrs. Sharon Winstead Pettiford

Title

Ceo

Phone

(919) 550-2648

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Rose of Sharon Adolescent Treatment Home II

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243900800000",
    "number": "1629113170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 KENTUCKY DERBY DR",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275206080",
            "telephone_number": "919-550-2648",
            "fax_number": "919-550-2648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2885 BENNINGTON DR",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275205971",
            "telephone_number": "919-553-3383",
            "fax_number": "919-550-2648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSE OF SHARON ADOLESCENT TREATMENT HOME II",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ROSE OF SHARON ADOLESCENT TREATMENT HOME",
        "enumeration_date": "2007-02-21",
        "last_updated": "2009-06-02",
        "status": "A",
        "authorized_official_last_name": "PETTIFORD",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "WINSTEAD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-550-2648",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "051153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604153",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nakisha Deshawn Rodriguez, LCMHCS
• Addison Austin Roe
• Harold Edward Rogers, D.D.S.
• Jacqueline Louise Rookwood, MD
• Rose of Sharon Adolescent Treatment Home II
• Nicole Renee Rose, M.A. LPC, LCAS
• Anna Ross, PHARMD
• RPM Functional Neuromuscular Massage Therapy, Inc.
• Rsa Johnston LLC
• Justin Michael Runyon

• Emotionally Disturbed Childrens' Residential Treatment Facility in Clayton, NC
• Providers in Clayton, 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 Jun 2, 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.