NPIMap

Organization Active NPI

Eason Court Group Home

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Youngsville, NC
National Provider Identifier
1790861334
Registry record updated Dec 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
MHL-035-029 Issued in NC
Legal business name
EASON COURT GROUP HOME
Practice address
113 Eason CT
Youngsville, NC 27596-9228
Phone
(919) 556-4720
Fax
(919) 556-3003
NPI assigned
Oct 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2011

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

Authorized official

Name
Ms. Daphine Lloyd Carroll
Title
Executive Director
Phone
(919) 556-4720

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL-035-029 NC Primary

Addresses

Primary practice location

113 Eason CT
Youngsville, NC 27596-9228

Mailing address

PO Box 759
Youngsville, NC 27596-0759
Phone (919) 556-4720

Other identifiers 1

IdentifierTypeStateIssuer
3418180MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Eason Court3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325116800000",
    "number": "1790861334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 759",
            "city": "YOUNGSVILLE",
            "state": "NC",
            "postal_code": "275960759",
            "telephone_number": "919-556-4720",
            "fax_number": "919-556-3003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 EASON CT",
            "city": "YOUNGSVILLE",
            "state": "NC",
            "postal_code": "275969228",
            "telephone_number": "919-556-4720",
            "fax_number": "919-556-3003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASON COURT GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2011-12-29",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "DAPHINE",
        "authorized_official_middle_name": "LLOYD",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "919-556-4720",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-035-029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3418180",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Youngsville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2011; 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.