Dickens Group Home, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

DICKENS GROUP HOME, LLC

Practice address

10719 Starwood Ave
Charlotte, NC 28215-9587

Phone

(704) 906-1519

Fax

(704) 573-9407

NPI assigned

Jul 14, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Jerome Dickens

Title

Executive Director

Phone

(704) 906-1519

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1215993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1942464409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10719 STARWOOD AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282159587",
            "telephone_number": "704-906-1519",
            "fax_number": "704-573-9407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10719 STARWOOD AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282159587",
            "telephone_number": "704-906-1519",
            "fax_number": "704-573-9407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKENS GROUP HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-14",
        "last_updated": "2008-07-14",
        "status": "A",
        "authorized_official_last_name": "DICKENS",
        "authorized_official_first_name": "JEROME",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "704-906-1519",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Graziella Dichoso-Wood, MD
• Jennifer Renee Dicicco, DPT
• Justin Dick, DC
• Kayla Dick
• Melissa J Dickard, IBCLC
• Courtney Dupree Dickens, LCMHCA
• Deborah Dickens
• Carrie Dickenson, MSW
• Lori Bizzell Dickenson, CRNA
• Anne Godfrey Dickerson, LPC

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 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.