Ely Enterprises, Inc.

Primary specialty

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

License

MHL-047-049 Issued in NC

Legal business name

ELY ENTERPRISES, INC.

Practice address

3999 Fayetteville Road
Raeford, NC 28376-0274

Phone

(910) 683-6476

Fax

(910) 683-6476

NPI assigned

Jun 27, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Calvin Donnell Ely

Title

Co-Administrator

Phone

(910) 683-6476

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241740800000",
    "number": "1881891521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 274",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283760274",
            "telephone_number": "910-683-6476",
            "fax_number": "910-683-6476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3999 FAYETTEVILLE ROAD",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283760274",
            "telephone_number": "910-683-6476",
            "fax_number": "910-683-6476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELY ENTERPRISES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-27",
        "last_updated": "2009-05-08",
        "status": "A",
        "authorized_official_last_name": "ELY",
        "authorized_official_first_name": "CALVIN",
        "authorized_official_middle_name": "DONNELL",
        "authorized_official_title_or_position": "CO-ADMINISTRATOR",
        "authorized_official_telephone_number": "910-683-6476",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-047-049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3418202",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804458",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Raeford, NC
• Providers in Raeford, 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 May 8, 2009; 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.