Premier Residential for Kids Inc.

Primary specialty

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

License

MHL-068-144 Issued in NC

Legal business name

PREMIER RESIDENTIAL FOR KIDS INC.

Practice address

516 Revere Rd
Hillsborough, NC 27278-2089

Phone

(919) 241-4557

NPI assigned

Mar 4, 2010

Last updated

Jun 20, 2018By 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

Mrs. Ebony P Smith

Title

Owner/Director

Phone

(336) 407-0424

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1267660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1760705859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516A REVERE ROAD",
            "city": "HILLSBOROUGH",
            "state": "NC",
            "postal_code": "27278",
            "telephone_number": "919-241-4557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 REVERE RD",
            "city": "HILLSBOROUGH",
            "state": "NC",
            "postal_code": "272782089",
            "telephone_number": "919-241-4557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER RESIDENTIAL FOR KIDS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-04",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "EBONY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "336-407-0424",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-068-144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dana Pierson, MSPT
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• Carley Prenshaw, M.S., CCC-SLP
• Philip A Price, PA
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• Private Diagnostic Clinic, PLLC (NC Orthopaedic Clinic-Hillsborough)
• Janelle Elizabeth Puckett, MS, CCC-SLP

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Hillsborough, NC
• Providers in Hillsborough, 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 Jun 20, 2018; 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.