Pentecostal Temple Residential Services, Inc.

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

MHL-115 Issued in NC

Legal business name

PENTECOSTAL TEMPLE RESIDENTIAL SERVICES, INC.

Practice address

2753 W 5TH St
Greenville, NC 27834-7817

Phone

(252) 752-0057

Fax

(252) 830-4094

NPI assigned

Oct 2, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Christina Sims-Smith, BS, QP

Title

Clinical Director

Phone

(252) 752-6951

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902999568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 983",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278350983",
            "telephone_number": "252-752-0057",
            "fax_number": "252-830-4094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2753 W 5TH ST",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278347817",
            "telephone_number": "252-752-0057",
            "fax_number": "252-830-4094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENTECOSTAL TEMPLE RESIDENTIAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SIMS-SMITH",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "252-752-6951",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BS, QP"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Frances Pender, MSN RNC NNP
• Emilie Pendley, M.D.
• Ashley Paige Penland, RDN, LDN
• Akhil Penmetcha, MD
• Molly Pennisi
• Carol Peoples, MS, CCC-SLP
• Ann E Peralta, LCMHC,LPC, LCAS
• Philip Sutherland Perdue Jr., M.D.
• Anthony Carlos Pereira, LAT, ATC
• Rebekah R. Perez, AUD

• Emotionally Disturbed Childrens' Residential Treatment Facility in Greenville, NC
• Providers in Greenville, NC by specialty
• Emotionally Disturbed Childrens' 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.