NPIMap

Organization Active NPI

Alberta Professional Services

Doing business as Booth Road Group Home

  • Psychiatric Residential Treatment Facility
  • Chapel Hill, NC
National Provider Identifier
1659515559
Registry record updated Jul 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
License
MHL-068-138 Issued in NC
Legal business name
ALBERTA PROFESSIONAL SERVICES
Doing business as
Booth Road Group Home
Practice address
130 Booth Rd
Chapel Hill, NC 27516-9643
Phone
(919) 967-5591
Fax
(336) 273-6522
NPI assigned
Apr 23, 2009
Last updated
Jul 26, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
ALBERTA PROFESSIONAL SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 26, 2016

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

Authorized official

Name
Mr. Derek Mitchell, BS, QP
Title
Operations Manager
Phone
(336) 273-2640

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X MHL-068-138 NC Primary

Addresses

Primary practice location

130 Booth Rd
Chapel Hill, NC 27516-9643

Mailing address

3107 S Elm Eugene St
Building a
Greensboro, NC 27406-5201
Phone (336) 273-2640

Other identifiers 1

IdentifierTypeStateIssuer
7806103MedicaidNC

Other names 1

  • Booth Road Group Home Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Alberta Professional Serviceds9 organizations share this tax ID, including this one
Part of
Alberta Professional Serviceds

Other organizations with this tax ID 8

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": "1240444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469491200000",
    "number": "1659515559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3107 S ELM EUGENE ST",
            "address_2": "BUILDING A",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274065201",
            "telephone_number": "336-273-2640",
            "fax_number": "336-273-6522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 BOOTH RD",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275169643",
            "telephone_number": "919-967-5591",
            "fax_number": "336-273-6522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBERTA PROFESSIONAL SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALBERTA PROFESSIONAL SERVICES",
        "enumeration_date": "2009-04-23",
        "last_updated": "2016-07-26",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "336-273-2640",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BS, QP"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "NC",
            "license": "MHL-068-138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7806103",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Booth Road Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chapel Hill, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2016; 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.