NPIMap

Organization Active NPI

People of Potential, Inc

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Jacksonville, NC
National Provider Identifier
1902928765
Registry record updated Sep 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
MHL067100 Issued in NC
Legal business name
PEOPLE OF POTENTIAL, INC
Practice address
113 Courtland Dr
Jacksonville, NC 28546-6017
Phone
(910) 989-1224
NPI assigned
Apr 4, 2007
Last updated
Sep 5, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
PEOPLE OF POTENTIAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 5, 2012

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

Authorized official

Name
Ms. Dawn L McCullenNPI 1609058494
Title
Presidential
Phone
(901) 989-1224

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X MHL067034 NC
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X MHL067100 NC Primary

Addresses

Primary practice location

113 Courtland Dr
Jacksonville, NC 28546-6017

Mailing address

1001 Henderson Dr
Jacksonville, NC 28540-7423
Phone (910) 989-1224

Other identifiers 1

IdentifierTypeStateIssuer
3409608MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
People of Potential Inc4 organizations share this tax ID, including this one
Part of
People of Potential Inc

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346803200000",
    "number": "1902928765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 HENDERSON DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285407423",
            "telephone_number": "910-989-1224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 COURTLAND DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466017",
            "telephone_number": "910-989-1224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEOPLE OF POTENTIAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEOPLE OF POTENTIAL INC",
        "enumeration_date": "2007-04-04",
        "last_updated": "2012-09-05",
        "status": "A",
        "authorized_official_last_name": "MCCULLEN",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENTIAL",
        "authorized_official_telephone_number": "901-989-1224",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL067034",
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL067100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3409608",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2012; 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.