Amazing Queens Group Home LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

AMAZING QUEENS GROUP HOME LLC

Practice address

910 Jenkins Farm Rd
Pinetops, NC 27864-7022

Phone

(252) 640-9194

NPI assigned

Jun 18, 2025

Last updated

Jun 18, 2025By 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

Ms. Tawanda Tenika TilleryNPI 1619794856

Title

Owner

Phone

(252) 640-9194

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tawanda Tenika Tillery

  • Community Health Worker
  • Pinetops, NC
  • NPI 1619794856
  NPD Authorized official

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

{
    "created_epoch": "1750204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750204800000",
    "number": "1821985375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 JENKINS FARM RD",
            "city": "PINETOPS",
            "state": "NC",
            "postal_code": "278647022",
            "telephone_number": "252-640-9194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 JENKINS FARM RD",
            "city": "PINETOPS",
            "state": "NC",
            "postal_code": "278647022",
            "telephone_number": "252-640-9194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMAZING QUEENS GROUP HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-18",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A",
        "authorized_official_last_name": "TILLERY",
        "authorized_official_first_name": "TAWANDA",
        "authorized_official_middle_name": "TENIKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-640-9194",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samanda Barnes
• Taylor Andrew Braswell, PA-C
• Johnna Lee Brothers, FNP-C
• Lisa Yancey Coltrane, MSN, RNCS, FNP
• Comprehensive Behavioral

• Mental Illness Community Based Residential Treatment Facility in Pinetops, NC
• Providers in Pinetops, NC by specialty
• Mental Illness Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2025; 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.