NPIMap

Bridgebuilders

Organization Active NPI Emotionally Disturbed Childrens' Residential Treatment Facility · Kings MTN, NC

NPI 1720142847 · NPPES record last updated Aug 1, 2007

Key facts

NPI
1720142847
Entity type
Organization (NPI type 2)
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X
License
MHL030463 (NC)
Legal business name
BRIDGEBUILDERS
Practice address
606 Hillside Dr
Kings MTN, NC 28086-3219
Phone
(704) 864-4623
Fax
(704) 864-3331
NPI assigned
Dec 21, 2006
Organization subpart
No

Authorized official

Name
Mr. Vernon T Grier
Title
Chief Executive Officer
Phone
(704) 864-4623

Corporate family (same tax ID) 9

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

National Provider Directory

Tax ID family
Bridgebuilders Family Youth Services Inc (10 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL030463 NC Yes

Addresses

Primary practice location

606 Hillside Dr
Kings MTN, NC 28086-3219

Mailing address

PO Box 3707
Gastonia, NC 28054-0020
Phone (704) 864-4623

Other identifiers

IdentifierTypeStateIssuer
6603957MedicaidNC

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 1, 2007.

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185926400000",
    "number": "1720142847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3707",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280540020",
            "telephone_number": "704-864-4623",
            "fax_number": "704-864-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 HILLSIDE DR",
            "city": "KINGS MTN",
            "state": "NC",
            "postal_code": "280863219",
            "telephone_number": "704-864-4623",
            "fax_number": "704-864-3331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEBUILDERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2007-08-01",
        "status": "A",
        "authorized_official_last_name": "GRIER",
        "authorized_official_first_name": "VERNON",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "704-864-4623",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL030463",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603957",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kings MTN, NC

All providers in Kings MTN, NC · Emotionally Disturbed Childrens' Residential Treatment Facility in North Carolina

Sources for this page

Verify at the official NPI Registry.