NPIMap

Organization Active NPI

Jessie'S Place

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Macon, NC
National Provider Identifier
1699953497
Registry record updated Feb 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
MHL-093-043 Issued in NC
Legal business name
JESSIE'S PLACE
Practice address
516 Macon Embro Rd
Macon, NC 27551-9287
Phone
(252) 257-1814
NPI assigned
Feb 4, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2008

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

Authorized official

Name
Mr. Cornelius Williams
Title
Administrator
Phone
(252) 257-1814

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL-093-043 NC Primary

Addresses

Primary practice location

516 Macon Embro Rd
Macon, NC 27551-9287

Mailing address

516 Macon Embro Rd
Macon, NC 27551-9287
Phone (252) 257-1814

Other identifiers 2

IdentifierTypeStateIssuer
7805430MedicaidNC
3418181MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Guardian Angel Healthcarellc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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": "1202083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202083200000",
    "number": "1699953497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 MACON EMBRO RD",
            "city": "MACON",
            "state": "NC",
            "postal_code": "275519287",
            "telephone_number": "252-257-1814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 MACON EMBRO RD",
            "city": "MACON",
            "state": "NC",
            "postal_code": "275519287",
            "telephone_number": "252-257-1814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESSIE'S PLACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-04",
        "last_updated": "2008-02-04",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "CORNELIUS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "252-257-1814",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-093-043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805430",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3418181",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2008; 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.