NPIMap

Organization Active NPI

Sanctuary House

  • Community/Behavioral Health Agency
  • Greensboro, NC
National Provider Identifier
1720219330
Registry record updated Oct 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
SANCTUARY HOUSE
Practice address
411 W Fisher Ave
Greensboro, NC 27401-2039
Phone
(336) 275-7896
NPI assigned
Jul 30, 2009
Last updated
Oct 4, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2021

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

Authorized official

Name
Mrs. Elizabeth Theisen
Title
Operations
Phone
(336) 275-7896

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

411 W Fisher Ave
Greensboro, NC 27401-2039

Mailing address

518 N Elm St
Greensboro, NC 27401-2018

Other practice location 1

518 N Elm St
Greensboro, NC 27401-2018
Phone (336) 275-7896

Other identifiers 1

IdentifierTypeStateIssuer
6006775MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221229002713 NC Part B Supplier - Clinic/Group Practice 0941326920 Receives reassigned benefits from 5 practitioners
Practice locations: Greensboro, NC

National Provider Directory

National Provider Directory
Tax ID family
Sanctuary House5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

231 N Spring St
Unit A
Greensboro, NC 27401
Phone (336) 271-2886

411 W Fisher Ave
Greensboro, NC 27401
Phone (336) 275-7896

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1248912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633305600000",
    "number": "1720219330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "518 N ELM ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274012018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 W FISHER AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274012039",
            "telephone_number": "336-275-7896"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "518 N Elm St",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274012018",
            "country_code": "US",
            "telephone_number": "336-275-7896",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SANCTUARY HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-30",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A",
        "authorized_official_last_name": "THEISEN",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "OPERATIONS",
        "authorized_official_telephone_number": "336-275-7896",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006775",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.