Extended Reach Daytreatment for Children and Adolescents

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

MHL-026-852 Issued in NC

Legal business name

EXTENDED REACH DAYTREATMENT FOR CHILDREN AND ADOLESCENTS

Practice address

302 Bradford Ave
Fayetteville, NC 28301-5406

Phone

(910) 484-0095

Fax

(919) 238-7287

NPI assigned

Feb 14, 2011

Last updated

Jul 15, 2014By 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. Andrea Monique Boatman

Title

Ceo

Phone

(910) 229-8256

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Extended Reach Day Treatment Other name

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

{
    "created_epoch": "1297641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405382400000",
    "number": "1821395674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 BRADFORD AVE",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283015406",
            "telephone_number": "910-484-0095",
            "fax_number": "919-238-7287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 BRADFORD AVE",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283015406",
            "telephone_number": "910-484-0095",
            "fax_number": "919-238-7287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDED REACH DAYTREATMENT FOR CHILDREN AND ADOLESCENTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-14",
        "last_updated": "2014-07-15",
        "status": "A",
        "authorized_official_last_name": "BOATMAN",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "MONIQUE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-229-8256",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "MHL-026-852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8302981",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8302339",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3410184",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006927",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Extended Reach Day Treatment",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Express Discount Pharmacy LLC
• Expressive Beginnings Speech-Language Pathology Services, PLLC
• Extelle Hair Studio
• Extended Reach Day Treatment for Children & Adolescents LLC
• Extended Reach Day Treatment for Children and Adolescents, LLC
• Extended Reach Daytreatment for Childrena and Adolescents LLC
• Extensions of Living, L.L.C.
• Eye Medics Optometry PA (Eye Medics Adult & Pediactric Eye Care)
• Eye Tech Optical Inc (Eye Tech Optical)
• Eyecarecenter OD PA

• Community/Behavioral Health Agency in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; 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.