Wicker Street Group Home

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

001-217 Issued in NC

Legal business name

WICKER STREET GROUP HOME

Practice address

1620 Flora Ave
Burlington, NC 27217-1018

Phone

(336) 227-4350

Fax

(336) 227-4350

NPI assigned

Jul 19, 2011

Organization subpart

No

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

Authorized official

Name

Ms. Dorothea Vivian Rogers

Title

Director/Owner

Phone

(336) 578-0004

Specialties & licenses 1

Addresses

Tax ID family

Green Valley Haven Group Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Green Valley Haven, LLC

  dba Green Valley Haven Group Home

  • Adult Care Home Facility
  • Burlington, NC
  • NPI 1164708897
  NPD tax ID

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

{
    "created_epoch": "1311033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739318400000",
    "number": "1861780322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 981",
            "city": "HAW RIVER",
            "state": "NC",
            "postal_code": "272580981",
            "telephone_number": "336-578-0004",
            "fax_number": "336-227-4350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 FLORA AVE",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272171018",
            "telephone_number": "336-227-4350",
            "fax_number": "336-227-4350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICKER STREET GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-19",
        "last_updated": "2025-02-12",
        "certification_date": "2025-01-24",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "DOROTHEA",
        "authorized_official_middle_name": "VIVIAN",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "336-578-0004",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "NC",
            "license": "001-217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daphne Roxan White, RPH
• Elizabeth B White, N.P.
• Judy Dianne White, BSN, RN
• Monica Lenette Whitlock, LCMHC
• Willaim D Whitsett, DDS
• Robb Jay Wiegand, M.D.
• Susan Kathleen Wies, LCSW-A
• Wiley Transit Care LLC
• Joyita Kwamina Wiley-Jones
• Edra Wiley

• Assisted Living Facility (Mental Illness) in Burlington, NC
• Providers in Burlington, NC by specialty
• Assisted Living Facility (Mental Illness) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 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.