NPIMap

Organization Active NPI

Professional Group Living, LLC

  • Community/Behavioral Health Agency
  • Clinton, NC
National Provider Identifier
1750522165
Registry record updated Mar 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
8109498 Issued in NC
Legal business name
PROFESSIONAL GROUP LIVING, LLC
Practice address
715 Southwest Blvd.
B
Clinton, NC 28328-4829
Phone
(919) 592-2338
Fax
(919) 592-5508
NPI assigned
Mar 13, 2009
Last updated
Mar 13, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2009

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

Authorized official

Name
Llewellyn Hicks, MSW
Title
Director
Phone
(919) 475-6124

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X 8109498 NC
Community/Behavioral Health Agency 251S00000X 8109498 NC Primary

Addresses

Primary practice location

715 Southwest Blvd.
B
Clinton, NC 28328-4829

Mailing address

510 Simmons St
Durham, NC 27701-4334
Phone (919) 688-0818

National Provider Directory

National Provider Directory
Tax ID family
Professional Group Living LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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": "1236902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236902400000",
    "number": "1750522165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 SIMMONS ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277014334",
            "telephone_number": "919-688-0818",
            "fax_number": "919-688-0918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 SOUTHWEST BLVD.",
            "address_2": "B",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283284829",
            "telephone_number": "919-592-2338",
            "fax_number": "919-592-5508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL GROUP LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-13",
        "last_updated": "2009-03-13",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "LLEWELLYN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "919-475-6124",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NC",
            "license": "8109498",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "8109498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 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.