Our Fathers Place Inc

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

MHL049095 Issued in NC

Legal business name

OUR FATHERS PLACE INC

Practice address

115 North Oakwood Drive
Stateville, NC 28677-5325

Phone

(704) 872-0313

Fax

(704) 872-7787

NPI assigned

Dec 19, 2006

Last updated

Aug 22, 2020By 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

Mr. James Russell Linton, MED

Title

Cheif Executive Officer

Phone

(704) 684-0197

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Our Fathers Place Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• Our Fathers Place Inc

  • Mental Illness Community Based Residential Treatment Facility
  • Statesville, NC
  • NPI 1275637423
  NPD tax ID
• Our Fathers Place Inc

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Statesville, NC
  • NPI 1346303187
  NPD tax ID
• Our Fathers Place Inc

  • Community/Behavioral Health Agency
  • Statesville, NC
  • NPI 1679741714
  NPD tax ID

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831252675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "256 EAST BROAD STREET",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286775325",
            "telephone_number": "704-872-0313",
            "fax_number": "704-872-7787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 NORTH OAKWOOD DRIVE",
            "city": "STATEVILLE",
            "state": "NC",
            "postal_code": "286775325",
            "telephone_number": "704-872-0313",
            "fax_number": "704-872-7787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUR FATHERS PLACE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LINTON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "CHEIF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "704-684-0197",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MED"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL049095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603748",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.