Dwayne'S Extended Family Services, Inc.

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

MHL-041-627 Issued in NC

Legal business name

DWAYNE'S EXTENDED FAMILY SERVICES, INC.

Practice address

1421 Walnut St
Greensboro, NC 27405-6648

Phone

(336) 638-3494

Fax

(336) 638-3494

NPI assigned

Jan 2, 2007

Organization subpart

No

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

Authorized official

Name

Dwayne Tripp

Title

Owner

Phone

(336) 638-3494

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831256858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 BALES CHAPEL RD",
            "city": "JAMESTOWN",
            "state": "NC",
            "postal_code": "272829149",
            "telephone_number": "336-638-3494",
            "fax_number": "336-638-3494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 WALNUT ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274056648",
            "telephone_number": "336-638-3494",
            "fax_number": "336-638-3494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DWAYNE'S EXTENDED FAMILY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TRIPP",
        "authorized_official_first_name": "DWAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-638-3494"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-041-627",
            "primary": true
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-041-676",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tieshia Ann Durant, NP
• Alison Adams Durham, D.P.M
• Christopher L Durham, DDS
• Kawanta Foster Durham, M.D.
• Kenan Durham
• Dwell Ministry PC
• Dynamic Duo Counseling PLLC
• Rachel Dyrhaug, FNP
• Karen Marie Dzingle, FNP-BC
• Nancy Eades

• Emotionally Disturbed Childrens' Residential Treatment Facility in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in North Carolina

• 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.