Self-Determination LLC

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

SELF-DETERMINATION LLC

Practice address

103 Ebenezer Rd
Kings MTN, NC 28086

Phone

(704) 750-4752

Fax

(704) 750-4753

NPI assigned

Dec 9, 2009

Organization subpart

No

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

Authorized official

Name

Floydce Jefferies

Title

President

Phone

(828) 433-0465

Specialties & licenses 6

Addresses

Other identifiers 1

Tax ID family

Self Determination LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Self Determination, LLC

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Lenoir, NC
  • NPI 1568852424
  NPD tax ID
• Self Determination, LLC

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Shelby, NC
  • NPI 1972954113
  NPD tax ID

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

{
    "created_epoch": "1260316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533859200000",
    "number": "1639408248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 EBENEZER RD",
            "city": "KINGS MTN",
            "state": "NC",
            "postal_code": "280868762",
            "telephone_number": "704-750-4752",
            "fax_number": "704-750-4753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 EBENEZER RD",
            "city": "KINGS MTN",
            "state": "NC",
            "postal_code": "28086",
            "telephone_number": "704-750-4752",
            "fax_number": "704-750-4753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF-DETERMINATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-09",
        "last_updated": "2018-08-10",
        "status": "A",
        "authorized_official_last_name": "JEFFERIES",
        "authorized_official_first_name": "FLOYDCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "828-433-0465"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "023-197",
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "012-129",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604454",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Case Management Agency in Kings MTN, NC
• Providers in Kings MTN, NC by specialty
• Case Management Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2018; 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.