Concordia, Seabrooks, & Miles Ptnrs

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

MHL-067-154 Issued in NC

Legal business name

CONCORDIA, SEABROOKS, & MILES PTNRS

Practice address

1903 Bragg Blvd
Suite 4
Fayetteville, NC 28303-4563

Phone

(910) 826-8253

Fax

(910) 826-8254

NPI assigned

Oct 10, 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

Meredith Nickelberry

Title

Vice President

Phone

(910) 826-8253

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871681551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26108",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283145018",
            "telephone_number": "910-826-8253",
            "fax_number": "910-826-8254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1903 BRAGG BLVD",
            "address_2": "SUITE 4",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283034563",
            "telephone_number": "910-826-8253",
            "fax_number": "910-826-8254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCORDIA, SEABROOKS, & MILES PTNRS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NICKELBERRY",
        "authorized_official_first_name": "MEREDITH",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "910-826-8253"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-067-154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603570",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603687",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Intellectual and/or Developmental Disabilities 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.