Essential Supportive Services, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

ESSENTIAL SUPPORTIVE SERVICES, LLC

Practice address

112 S Ellington St
Clayton, NC 27520-2306

Phone

(919) 550-0639

NPI assigned

Jan 22, 2009

Organization subpart

No

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

Authorized official

Name

Ms. Crystal A Goldston

Title

Officer

Phone

(919) 550-0639

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1232582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478476800000",
    "number": "1790923217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 S. ELLINGTON ST.",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275206566",
            "telephone_number": "919-550-0639",
            "fax_number": "919-550-0993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 S ELLINGTON ST",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275202306",
            "telephone_number": "919-550-0639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESSENTIAL SUPPORTIVE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-22",
        "last_updated": "2016-11-07",
        "status": "A",
        "authorized_official_last_name": "GOLDSTON",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "919-550-0639",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; 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.