NPIMap

Organization Active NPI

Pelham Supportive Services

  • Mental Illness Community Based Residential Treatment Facility
  • Fayetteville, NC
National Provider Identifier
1710144738
Registry record updated May 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
MHL-026-824 Issued in NC
Legal business name
PELHAM SUPPORTIVE SERVICES
Practice address
4906 Redwood Dr
Fayetteville, NC 28304-4213
Phone
(910) 826-2990
NPI assigned
May 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2008

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

Authorized official

Name
Mildred Wilson
Title
Director
Phone
(910) 630-6757

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X MHL-026-824 NC Primary

Addresses

Primary practice location

4906 Redwood Dr
Fayetteville, NC 28304-4213

Mailing address

949 Country Club Dr
Fayetteville, NC 28301-2907
Phone (910) 630-6757

Other names 1

  • PELHAM GROUP HOME #2 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pelham Supportive Services6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1211155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211155200000",
    "number": "1710144738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "949 COUNTRY CLUB DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283012907",
            "telephone_number": "910-630-6757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4906 REDWOOD DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044213",
            "telephone_number": "910-826-2990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PELHAM SUPPORTIVE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-19",
        "last_updated": "2008-05-19",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MILDRED",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "910-630-6757"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL-026-824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PELHAM GROUP HOME #2",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 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.