NPIMap

Organization Active NPI

Marys Major III

  • Mental Illness Community Based Residential Treatment Facility
  • Raleigh, NC
National Provider Identifier
1891819389
Registry record updated Jul 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
MHL 092 351 Issued in NC
Legal business name
MARYS MAJOR III
Practice address
4208 Labrador Drive
Raleigh, NC 27616-9746
Phone
(919) 261-0572
Fax
(919) 266-7901
NPI assigned
Mar 19, 2007
Reactivated
Jul 9, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2008

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

Authorized official

Name
Ms. Mary Lilly McCullers-Jackson
Title
Owner Administrator
Phone
(919) 266-5291

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X MHL 092 351 NC
Mental Illness Community Based Residential Treatment Facility 320800000X MHL 092 351 NC Primary

Addresses

Primary practice location

4208 Labrador Drive
Raleigh, NC 27616-9746

Mailing address

5641 Quail Covey Lane
Wendell, NC 27591-7901
Phone (919) 266-5291

National Provider Directory

National Provider Directory
Tax ID family
Mary L McCullers-Jackson3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215561600000",
    "number": "1891819389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5641 QUAIL COVEY LANE",
            "city": "WENDELL",
            "state": "NC",
            "postal_code": "275917901",
            "telephone_number": "919-266-5291",
            "fax_number": "919-266-7901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4208 LABRADOR DRIVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276169746",
            "telephone_number": "919-261-0572",
            "fax_number": "919-266-7901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYS MAJOR III",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2008-07-09",
        "deactivation_date": "2008-06-04",
        "reactivation_date": "2008-07-09",
        "status": "A",
        "authorized_official_last_name": "MCCULLERS-JACKSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "LILLY",
        "authorized_official_title_or_position": "OWNER ADMINISTRATOR",
        "authorized_official_telephone_number": "919-266-5291",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "MHL 092 351",
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL 092 351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; 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.