NPIMap

Organization Active NPI

Pembroke Center for Wellness, Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • Pembroke, NC
National Provider Identifier
1699008144
Registry record updated Nov 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
PEMBROKE CENTER FOR WELLNESS, INC
Practice address
773 Old Main Rd
Pembroke, NC 28372-8753
Phone
(910) 775-9201
Fax
(910) 521-8540
NPI assigned
Sep 16, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2025

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

Authorized official

Name
Ella LynchNPI 1184611139
Title
Owner
Phone
(910) 740-3508

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

773 Old Main Rd
Pembroke, NC 28372-8753

Mailing address

PO Box 3605
Pembroke, NC 28372-3605
Phone (910) 775-9201

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100208000747 NC Part B Supplier - Clinic/Group Practice 0941343271 Receives reassigned benefits from 3 practitioners
Practice locations: Pembroke, NC

National Provider Directory

National Provider Directory
Tax ID family
Pembroke Center for Wellness2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1253059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762128000000",
    "number": "1699008144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3605",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283723605",
            "telephone_number": "910-775-9201",
            "fax_number": "910-521-8540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "773 OLD MAIN RD",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283728753",
            "telephone_number": "910-775-9201",
            "fax_number": "910-521-8540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEMBROKE CENTER FOR WELLNESS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-16",
        "last_updated": "2025-11-03",
        "certification_date": "2025-11-03",
        "status": "A",
        "authorized_official_last_name": "LYNCH",
        "authorized_official_first_name": "ELLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-740-3508"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.