NPIMap

Individual provider Active NPI

Patsy Y. Camp

  • Mental Illness Community Based Residential Treatment Facility
  • Charlotte, NC
National Provider Identifier
1649310400
Registry record updated May 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Practice address
6421 Monteith Dr
Charlotte, NC 28213-6025
Phone
(704) 596-3493
NPI assigned
Feb 8, 2007
Last updated
May 15, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 15, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X NU Primary

Addresses

Primary practice location

6421 Monteith Dr
Charlotte, NC 28213-6025

Mailing address

4904 Hamilton Cir
Charlotte, NC 28216-2822
Phone (704) 535-4447

Other identifiers 1

IdentifierTypeStateIssuer
6604168MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Miracle Health Care Services LLC Current Accepting new patients
Miracle Houses Inc Current Accepting new patients
Miracle Houses Inc. Community Based Residential Treatment Facility, Mental Illness Past Accepting new patients

Organizations & group practices 16

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557878400000",
    "number": "1649310400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4904 HAMILTON CIR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282162822",
            "telephone_number": "704-535-4447",
            "fax_number": "704-535-4476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6421 MONTEITH DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282136025",
            "telephone_number": "704-596-3493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMP",
        "first_name": "PATSY",
        "middle_name": "Y.",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-08",
        "last_updated": "2019-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604168",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2019; 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.