NPIMap

Organization Active NPI

Piedmont Residential Development Center, Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Concord, NC
National Provider Identifier
1649334996
Registry record updated Sep 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
MHL-013-019 Issued in NC
Legal business name
PIEDMONT RESIDENTIAL DEVELOPMENT CENTER, INC
Practice address
5300 Hwy 200
Concord, NC 28025
Phone
(704) 788-2304
Fax
(704) 788-2951
NPI assigned
Dec 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2012

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

Authorized official

Name
Mrs. Sharon A Lipke
Title
Finance Director
Phone
(704) 788-2304

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X MHL-013-019 NC Primary

Addresses

Primary practice location

5300 Hwy 200
Concord, NC 28025

Mailing address

PO Box 909
Concord, NC 28026-0909
Phone (704) 788-2304

Other identifiers 1

IdentifierTypeStateIssuer
3406203MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Piedmont Residential Development Center Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348099200000",
    "number": "1649334996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 909",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280260909",
            "telephone_number": "704-788-2304",
            "fax_number": "704-788-2951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 HWY 200",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "28025",
            "telephone_number": "704-788-2304",
            "fax_number": "704-788-2951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIEDMONT RESIDENTIAL DEVELOPMENT CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2012-09-20",
        "status": "A",
        "authorized_official_last_name": "LIPKE",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "704-788-2304",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": "MHL-013-019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406203",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2012; 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.