NPIMap

Organization Active NPI

Pine Village Treatment Services

  • Community/Behavioral Health Agency
  • Fayetteville, NC
National Provider Identifier
1962517144
Registry record updated Oct 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MHL-047-096 Issued in NC
Legal business name
PINE VILLAGE TREATMENT SERVICES
Practice address
1206 Hope Mills Rd
Fayetteville, NC 28304-4215
Phone
(910) 864-7004
Fax
(910) 864-3002
NPI assigned
Aug 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2008

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

Authorized official

Name
Mr. Chris A Derepentigny
Title
Owner
Phone
(910) 864-7004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X MHL-047-096 NC Primary

Addresses

Primary practice location

1206 Hope Mills Rd
Fayetteville, NC 28304-4215

Mailing address

1206 Hope Mills Rd
Fayetteville, NC 28304-4215
Phone (910) 864-7004

Other identifiers 1

IdentifierTypeStateIssuer
8301247MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Pine Village Treatment Services 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": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222819200000",
    "number": "1962517144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1206 HOPE MILLS RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044215",
            "telephone_number": "910-864-7004",
            "fax_number": "910-864-3002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1206 HOPE MILLS RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044215",
            "telephone_number": "910-864-7004",
            "fax_number": "910-864-3002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE VILLAGE TREATMENT SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2008-10-01",
        "status": "A",
        "authorized_official_last_name": "DEREPENTIGNY",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-864-7004",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "MHL-047-096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301247",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 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.