MID-STATE HEALTH SYSTEMS, INC (NPI# 1023450723) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023450723 |
| Entity Type | Organization |
| Organization Name | MID-STATE HEALTH SYSTEMS, INC |
| Other Organization Name | MY PLACE |
| Practice Address |
1050 Hogan St Fayetteville NC 28311-2340 |
| Mailing Address |
3721 Legion Rd Hope Mills NC 28348-8411 |
| Practice Telephone | 9104843717 |
| Practice Fax Number | 9104841315 |
| Mailing Telephone | 9104843717 |
| Mailing Fax Number | 9104841315 |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2015-12-07 |
| Authorized Official Name | MRS. SERA GILMORE (ADMINISTRATOR) |
| Authorized Official Telephone | 9104843717 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | MHL-026-943 | NC | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| My Place | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851609085 | Mid-state Health Systems, Inc | Clinic/Center | 2908 Reynolda Rd, Winston Salem, NC 27106-3016 | 2010-09-22 |
| 1679762066 | Mid-state Health Systems, Inc | Community/Behavioral Health | 117 Beasley St, 2nd Floor, Kenansville, NC 28349 | 2007-10-22 |
| 1114005261 | Mid-state Health Systems, Inc | Community/Behavioral Health | 3721 Legion Rd, Hope Mills, NC 28348-8411 | 2006-11-02 |
| 1477634319 | Mid-state Health Systems, Inc | Intermediate Care Facility, Mentally Retarded | 4309 N.c. Hwy 87 S, Fayetteville, NC 28306-9818 | 2006-10-18 |
| 1083056782 | Mid-state Health Systems, Inc | Intermediate Care Facility, Mentally Retarded | 7559 Decatur Dr, Fayetteville, NC 28303-1989 | 2013-07-23 |
| 1477865541 | Mid-state Health Systems, Inc | Clinic/Center | 3721 Legion Rd, Hope Mills, NC 28348-8411 | 2010-07-06 |
| 1114168374 | Mid-state Health Systems, Inc | Community/Behavioral Health | 3721 Legion Rd, Hope Mills, NC 28348-8411 | 2009-03-18 |
| 1992865851 | Mid-state Health Systems, Inc | Case Management | 3721 Legion Rd, Hope Mills, NC 28348-8411 | 2006-12-11 |
| Street Address |
1050 HOGAN ST |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28311-2340 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356471874 | Peterkin & Associates | Assisted Living Facility | 1050 Hogan St, Fayetteville, NC 28311-2340 | 2007-03-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700415205 | Marcella Eubanks | Physical Therapy Assistant | Rdl Therapeutic Outpatient Therapy, 424 Mcarthur Rd, Fayetteville, NC 28311 | 2020-04-06 |
| 1144856709 | Laura Johnson | Occupational Therapy Assistant | 424 Mcarthur Rd., Fayetteville, NC 28311 | 2020-03-16 |
| 1326507096 | Senior Transportationl.l.c. | Private Vehicle | 164 Tallstone Dr, Fayetteville, NC 28311 | 2019-03-13 |
| 1154850998 | Shannon Marcella Chapman | Physical Therapist | 4140 Ramsey St Ste 110, Fayetteville, NC 28311 | 2017-06-06 |
| 1306392048 | Gena Oxendine | Counselor | 223 Glenola St, Fayetteville, NC 28311 | 2016-09-01 |
| 1023564010 | Rachel Sokolowski | Physical Therapy Assistant | 231 Treetop Dr., Fayetteville, NC 28311 | 2016-08-30 |
| 1285984765 | Towanaka Yvette Bass | Home Health Aide | 5688 Dobson Drive, Fayetteville, NC 28311 | 2012-09-12 |
| 1255574448 | Amy E. Southworth | Occupational Therapist | 3409 Connection Rd, Fayetteville, NC 28311 | 2009-04-17 |
| 1922246818 | Calhoun Family Pharmacy Inc | Pharmacy | 4417 Ramsey Street, Fayetteville, NC 28311 | 2009-01-30 |
| 1003051210 | Us Army | Clinic/Center | 5587 Lockridge Road, Fayetteville, NC 28311 | 2008-12-03 |
| Find all providers in zip 28311 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609299916 | Rha Health Services Nc, LLC | Intermediate Care Facility, Mentally Retarded | 1802 Strickland Bridge Rd, Fayetteville, NC 28304-5739 | 2014-01-23 |
| 1255574034 | Greater Image Healthcare, Corp | Intermediate Care Facility, Mentally Retarded | 401 Roberson Street, Fayetteville, NC 28301-5423 | 2009-04-09 |
| 1487799151 | Rha Health Services Nc, LLC | Intermediate Care Facility, Mentally Retarded | 2001 Southern Ave, Fayetteville, NC 28306-1757 | 2007-02-21 |
| 1467597708 | Rha Health Services Nc, LLC | Intermediate Care Facility, Mentally Retarded | 1818 Strickland Bridge Rd, Fayetteville, NC 28304-5739 | 2007-02-21 |
| 1912042797 | Rha Health Services Nc, LLC | Intermediate Care Facility, Mentally Retarded | 800 Old Wilmington Rd, Fayetteville, NC 28301-6210 | 2007-02-20 |
| 1740337757 | Davis & Associates, Inc | Intermediate Care Facility, Mentally Retarded | 1108 Quailmeadow Dr, Fayetteville, NC 28314-5936 | 2007-01-04 |
| 1699850891 | Sophia B Pierce & Associates Inc | Intermediate Care Facility, Mentally Retarded | 3301 Barksdale Road, Fayetteville, NC 28301 | 2006-10-26 |
| 1477634319 | Mid-state Health Systems, Inc | Intermediate Care Facility, Mentally Retarded | 4309 N.c. Hwy 87 S, Fayetteville, NC 28306-9818 | 2006-10-18 |
| 1083056782 | Mid-state Health Systems, Inc | Intermediate Care Facility, Mentally Retarded | 7559 Decatur Dr, Fayetteville, NC 28303-1989 | 2013-07-23 |
| 1922266816 | D & L Healthcare Services | Intermediate Care Facility, Mentally Retarded | 1108 Quailmeadow Dr, Fayetteville, NC 28314-5936 | 2008-05-28 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 28311 |
Please comment or provide details below to improve the information on MID-STATE HEALTH SYSTEMS, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.