NPIMap

Organization Active NPI

Three Forks Home

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Zionville, NC
National Provider Identifier
1780875138
Registry record updated Aug 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
MHL 095 043 Issued in NC
Legal business name
THREE FORKS HOME
Practice address
392 Camp Joy Road
Three Forks Home
Zionville, NC 28698-9759
Phone
(828) 350-1254
NPI assigned
Aug 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2007

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

Authorized official

Name
Mr. C. F. McDowell III
Title
Executive Vice President
Phone
(336) 474-1260

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL 095 043 NC Primary

Addresses

Primary practice location

392 Camp Joy Road
Three Forks Home
Zionville, NC 28698-9759

Mailing address

PO Box 338
Baptist Children'S Homes of NC, Inc
Thomasville, NC 27361-0338
Phone (336) 474-1260

Other identifiers 1

IdentifierTypeStateIssuer
MHL 095-043OtherNCSTATE LICENSE NUMBER

Other names 1

  • Baptist Children's Homes of NC, Inc. Other name

National Provider Directory

National Provider Directory
Tax ID family
Baptist Childrens Homes of NC Inc18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Locations

392 Camp Joy Rd
#Three
Zionville, NC 28698
Phone (828) 350-1254

NPI Registry JSON

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

{
    "created_epoch": "1186617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186617600000",
    "number": "1780875138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 338",
            "address_2": "BAPTIST CHILDREN'S HOMES OF NC, INC",
            "city": "THOMASVILLE",
            "state": "NC",
            "postal_code": "273610338",
            "telephone_number": "336-474-1260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "392 CAMP JOY ROAD",
            "address_2": "THREE FORKS HOME",
            "city": "ZIONVILLE",
            "state": "NC",
            "postal_code": "286989759",
            "telephone_number": "828-350-1254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE FORKS HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-09",
        "last_updated": "2007-08-09",
        "status": "A",
        "authorized_official_last_name": "MCDOWELL",
        "authorized_official_first_name": "C.",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "336-474-1260",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL 095 043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "MHL 095-043",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baptist Children's Homes of NC, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Zionville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2007; 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.