Lawrence Edward Graham Jr Youth Outreach Facility, Inc

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

MHL-078-201 Issued in NC

Legal business name

LAWRENCE EDWARD GRAHAM JR YOUTH OUTREACH FACILITY, INC

Practice address

9431 NC Highway 211 W
Red Springs, NC 28377-6001

Phone

(910) 843-5976

Fax

(910) 843-5976

NPI assigned

Jan 14, 2008

Last updated

Jan 14, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Rondla Graham Phillip

Title

Owner, President, Ceo

Phone

(910) 964-5034

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200268800000",
    "number": "1700062205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1952",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283763952",
            "telephone_number": "910-843-5976",
            "fax_number": "910-843-5976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9431 NC HIGHWAY 211 W",
            "city": "RED SPRINGS",
            "state": "NC",
            "postal_code": "283776001",
            "telephone_number": "910-843-5976",
            "fax_number": "910-843-5976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAWRENCE EDWARD GRAHAM JR YOUTH OUTREACH FACILITY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-14",
        "last_updated": "2008-01-14",
        "status": "A",
        "authorized_official_last_name": "PHILLIP",
        "authorized_official_first_name": "RONDLA",
        "authorized_official_middle_name": "GRAHAM",
        "authorized_official_title_or_position": "OWNER, PRESIDENT, CEO",
        "authorized_official_telephone_number": "910-964-5034",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL-078-201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Illness Community Based Residential Treatment Facility in Red Springs, NC
• Providers in Red Springs, NC by specialty
• Mental Illness Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 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.