Virginia Dare Behavorial Health Services Inc.

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

MHL040016 Issued in NC

Legal business name

VIRGINIA DARE BEHAVORIAL HEALTH SERVICES INC.

Doing business as

Virginia Dare Home C

Practice address

367 Lane Road
Stantonsburg, NC 27883

Phone

(252) 238-2622

Fax

(252) 238-6566

NPI assigned

Mar 19, 2007

Last updated

Aug 22, 2020By 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

Miss Phyllis Maxine Ward

Title

Administrator

Phone

(252) 238-2622

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Virginia Dare Home C Doing business as

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770607384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "367 LANE ROAD",
            "city": "STANTONSBURG",
            "state": "NC",
            "postal_code": "27883",
            "telephone_number": "252-238-2622",
            "fax_number": "252-238-6566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "367 LANE ROAD",
            "city": "STANTONSBURG",
            "state": "NC",
            "postal_code": "27883",
            "telephone_number": "252-238-2622",
            "fax_number": "252-238-6566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRGINIA DARE BEHAVORIAL HEALTH SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_middle_name": "MAXINE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "252-238-2622",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "NC",
            "license": "MHL040016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805104",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301320",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3409231",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Virginia Dare Home C",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Edwards Group Home 4
• Melody Meeks Flannery, MS, LCMHCA, LCAS, CR
• Life, Inc. (Wilson Dda)
• Stantonsburg Drug Company, Inc
• Stantonsburg Drug Company, Inc
• Wilson Medical Center, Inc. (Stantonsburg Medical Center)

• Preferred Provider Organization in Stantonsburg, NC
• Providers in Stantonsburg, NC by specialty
• Preferred Provider Organization in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.