NPIMap

Organization Active NPI

Peterkin & Associates, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Fayetteville, NC
National Provider Identifier
1740310978
Registry record updated Jan 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
MHL-026-071 Issued in NC
Legal business name
PETERKIN & ASSOCIATES, INC.
Practice address
235 Kinlaw Rd
Fayetteville, NC 28311-1431
Phone
(910) 323-1817
NPI assigned
Mar 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2012

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

Authorized official

Name
Alice Smith, ED.D.O
Title
Executive Director
Phone
(910) 323-1817

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X MHL-026-071 NC
Nursing Facility/Intermediate Care Facility 313M00000X MHL-026-071 NC
Intellectual Disabilities Intermediate Care Facility 315P00000X MHL-026-071 NC Primary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL-026-071 NC

Addresses

Primary practice location

235 Kinlaw Rd
Fayetteville, NC 28311-1431

Mailing address

131 Hay St Ste 201
Fayetteville, NC 28301-5649
Phone (910) 323-1817

Other identifiers 1

IdentifierTypeStateIssuer
3406050MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Peterkin Associates Inc12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326240000000",
    "number": "1740310978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 HAY ST STE 201",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283015649",
            "telephone_number": "910-323-1817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 KINLAW RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283111431",
            "telephone_number": "910-323-1817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERKIN & ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2012-01-11",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ALICE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "910-323-1817",
        "authorized_official_credential": "ED.D.O"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "MHL-026-071",
            "primary": false
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NC",
            "license": "MHL-026-071",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": "MHL-026-071",
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-026-071",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406050",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jan 11, 2012; 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.