NPIMap

Organization Active NPI

Pride in North Carolina, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Elizabeth City, NC
National Provider Identifier
1891850194
Registry record updated Oct 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
PRIDE IN NORTH CAROLINA, INC.
Practice address
1216 W Church St
Elizabeth City, NC 27909-4612
Phone
(252) 331-0322
Fax
(252) 331-0320
NPI assigned
Dec 27, 2006
Last updated
Oct 4, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2017

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

Authorized official

Name
Mr. Jason Rutski
Title
Director of Business Operations
Phone
(910) 452-1460

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary

Addresses

Primary practice location

1216 W Church St
Elizabeth City, NC 27909-4612

Mailing address

231 Commerce St
Greenville, NC 27858-5029
Phone (252) 321-8080

Other identifiers 4

IdentifierTypeStateIssuer
6604040MedicaidNC
6603947MedicaidNC
6603973MedicaidNC
6603852MedicaidNC

Other names 1

  • Pride in North Carolina, LLC Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Pride in North Carolina Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507075200000",
    "number": "1891850194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 COMMERCE ST",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278585029",
            "telephone_number": "252-321-8080",
            "fax_number": "252-321-7999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 W CHURCH ST",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279094612",
            "telephone_number": "252-331-0322",
            "fax_number": "252-331-0320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIDE IN NORTH CAROLINA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2017-10-04",
        "status": "A",
        "authorized_official_last_name": "RUTSKI",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS OPERATIONS",
        "authorized_official_telephone_number": "910-452-1460",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604040",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603947",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603973",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603852",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pride in North Carolina, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Elizabeth City, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2017; 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.