NPIMap

Organization Active NPI

Pitt County Group Home Board for Mentally Retarded, Autistic Persons,

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Ayden, NC
National Provider Identifier
1922358241
Registry record updated Nov 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
MHL-074-015 Issued in NC
Legal business name
PITT COUNTY GROUP HOME BOARD FOR MENTALLY RETARDED, AUTISTIC PERSONS,
Practice address
4263 N Edge Rd
Ayden, NC 28513-7185
Phone
(252) 524-4950
Fax
(252) 524-3870
NPI assigned
Sep 13, 2012
Last updated
Nov 16, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2012

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

Authorized official

Name
Mary Grace Bright
Title
Executive Director
Phone
(252) 524-4950

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL-074-015 NC Primary

Addresses

Primary practice location

4263 N Edge Rd
Ayden, NC 28513-7185

Mailing address

PO Box 9
Grifton, NC 28530-0009
Phone (252) 524-4950

Other identifiers 1

IdentifierTypeStateIssuer
3406530MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922358241. Details of each certification follow.

  • CCN 34G127 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 34G127

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
PITT COUNTY GROUP HOME #2
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Nov 7, 1989
Last certification
May 13, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
4263 North Edge Road
Ayden, NC 28513

National Provider Directory

National Provider Directory
Tax ID family
Pitt County Group Home Board for Mentally Retarded Autistic Persons6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1347494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353024000000",
    "number": "1922358241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "GRIFTON",
            "state": "NC",
            "postal_code": "285300009",
            "telephone_number": "252-524-4950",
            "fax_number": "252-524-3870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4263 N EDGE RD",
            "city": "AYDEN",
            "state": "NC",
            "postal_code": "285137185",
            "telephone_number": "252-524-4950",
            "fax_number": "252-524-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PITT COUNTY GROUP HOME BOARD FOR MENTALLY RETARDED, AUTISTIC PERSONS,",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-13",
        "last_updated": "2012-11-16",
        "status": "A",
        "authorized_official_last_name": "BRIGHT",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "GRACE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "252-524-4950"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-074-015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406530",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ayden, NC

Sources for this page

Verify at the official NPI Registry.