NPIMap

Organization Active NPI

Pelham Supportive Services

  • Community/Behavioral Health Agency
  • Saint Pauls, NC
National Provider Identifier
1649558933
Registry record updated Aug 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MNL-078-284 Issued in NC
Legal business name
PELHAM SUPPORTIVE SERVICES
Practice address
315 A West Broad Street
St Pauls, NC 28384-1535
Phone
(910) 865-3358
Fax
(910) 865-3358
NPI assigned
Aug 3, 2011
Last updated
Aug 3, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2011

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

Authorized official

Name
Mildred C Wilson
Title
President
Phone
(910) 630-6757

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X MNL-078-284 NC Primary

Addresses

Primary practice location

315 A West Broad Street
St Pauls, NC 28384-1535

Mailing address

949 Country Club Dr
Fayetteville, NC 28301-2907
Phone (910) 630-6757

National Provider Directory

National Provider Directory
Tax ID family
Pelham Supportive Services6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

315 W Broad St
#A
Saint Pauls, NC 28384
Phone (910) 865-3358

NPI Registry JSON

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

{
    "created_epoch": "1312329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312329600000",
    "number": "1649558933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "949 COUNTRY CLUB DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283012907",
            "telephone_number": "910-630-6757",
            "fax_number": "910-884-9804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 A WEST BROAD STREET",
            "city": "ST PAULS",
            "state": "NC",
            "postal_code": "283841535",
            "telephone_number": "910-865-3358",
            "fax_number": "910-865-3358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PELHAM SUPPORTIVE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-03",
        "last_updated": "2011-08-03",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MILDRED",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-630-6757"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "MNL-078-284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Pauls, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2011; 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.