Special Jewel Group Home

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

MHL064102 Issued in NC

Legal business name

SPECIAL JEWEL GROUP HOME

Practice address

200 S Tillery St
Rocky Mount, NC 27804-5527

Phone

(252) 446-6612

NPI assigned

Jul 24, 2009

Last updated

Jul 24, 2009By 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

Alice Clark

Title

Owner

Phone

(252) 446-6612

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1248393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248393600000",
    "number": "1730319773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 REGENCY DR",
            "city": "NASHVILLE",
            "state": "NC",
            "postal_code": "278561812",
            "telephone_number": "252-446-6612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S TILLERY ST",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278045527",
            "telephone_number": "252-446-6612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIAL JEWEL GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-24",
        "last_updated": "2009-07-24",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "ALICE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-446-6612"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL064102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Rocky Mount, NC
• Providers in Rocky Mount, NC by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2009; 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.