Tracey L Johnson

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

041771 Issued in NC

Legal business name

TRACEY L JOHNSON

Doing business as

Hampton Group Home

Practice address

115 Thornton CT
Greensboro, NC 27407-1429

Phone

(336) 323-2718

NPI assigned

Mar 28, 2007

Last updated

Jul 24, 2020By 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

Miss Tracey L Johnson

Title

Owneroperator

Phone

(336) 323-2718

Specialties & licenses 1

Addresses

Other names 1

• Hampton Group Home Doing business as

Tax ID family

Hampton Group Home2 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.

• Hampton Group Home

  • Assisted Living Facility
  • Greensboro, NC
  • NPI 1760056386
  NPD tax ID

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595548800000",
    "number": "1700905221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 THORNTON CT",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274071429",
            "telephone_number": "336-323-2718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 THORNTON CT",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274071429",
            "telephone_number": "336-323-2718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACEY L JOHNSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2020-07-24",
        "certification_date": "2020-07-24",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNEROPERATOR",
        "authorized_official_telephone_number": "336-323-2718",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "NC",
            "license": "041771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hampton Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility (Mental Illness) in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Assisted Living Facility (Mental Illness) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2020; 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.