EVANS WALSTON HOME LLC (NPI# 1063843274) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063843274 |
| Entity Type | Organization |
| Organization Name | EVANS WALSTON HOME LLC |
| Other Organization Name | EVANS WALSTON HOME |
| Practice Address |
808 Hawks View Ct Fuquay Varina NC 27526-6642 |
| Practice Telephone | 9195521312 |
| Practice Fax Number | 9195521312 |
| Mailing Telephone | 9195521312 |
| Enumeration Date | 2013-12-13 |
| Last Update Date | 2013-12-13 |
| Authorized Official Name | MRS. GLENDA JUDD EVANS WALSTON (OWNER/OPERATOR) |
| Authorized Official Telephone | 9195521312 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | MHL 092248 | NC | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Evans Walston Home | Doing Business As Name - Organization |
| Street Address |
808 HAWKS VIEW CT |
| City | FUQUAY VARINA |
| State | NC |
| Zip Code | 27526-6642 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336782721 | Leah C. Mcconkey | Speech-Language Pathologist | 305 Willow Grace Lane, Fuquay Varina, NC 27526 | 2019-10-18 |
| 1437617727 | Katherine Venable | Physician Assistant | 1418 N Main Street, Fuquay - Vanna, NC 27526 | 2019-03-06 |
| 1114403599 | Christine Newkirk | Social Worker | 344 Edgecroft Way, Fuquay Varina, NC 27526 | 2018-07-18 |
| 1851800536 | Pamela Trapp Johnson | Specialist | 196 Knight Estates Cir, Fuquay Varina, NC 27526 | 2017-09-25 |
| 1376908228 | Carrie Adeline Mitchell | Social Worker | 441 Leyland Cypress Ln, Fuquay Varina, NC 27526 | 2015-12-19 |
| 1235504267 | Keyana Sharlene Williams | Counselor | 602 E Academy St #205, Fuquay Varina, NC 27526 | 2015-12-02 |
| 1124452974 | Q1consultants, LLC | Community/Behavioral Health | 326 Daywood Creek Place, Fuquay, NC 27526 | 2013-08-29 |
| 1053759654 | Ellen Marie Macri | Developmental Therapist | 119 South Fuquay Avenue, Fuquay-varina, NC 27526 | 2013-06-05 |
| 1811239726 | Leslie H Yuan Gazdeck | Dentist | 1625 N Main St Ste 201, Fuquay Varina, NC 27526 | 2013-03-19 |
| 1093017725 | Joanne Scannell | Occupational Therapist | 119 South Fuquay Ave, Fuquay Varina, NC 27526 | 2010-12-01 |
| Find all providers in zip 27526 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164762035 | Judith's House | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2625 Mary Marvin Trl, Fuquay Varina, NC 27526-9641 | 2013-02-28 |
| 1316419658 | Purposeful Innovative Education Solutions LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1121 Powder Ct, Fuquay Varina, NC 27526-5571 | 2018-12-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306455126 | A Place 4 Me, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5305 Clearwater Lake Rd, Mount Holly, NC 28120-1445 | 2020-07-28 |
| 1922623792 | Our Home At Home LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4601 Waterford Knoll Dr Apt 1724, Charlotte, NC 28226-6015 | 2020-06-08 |
| 1922634484 | Tracey Holton | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Easterseals Ucp, 913 Carolina Ave N, Statesville, NC 28677 | 2020-03-17 |
| 1710443395 | Unity 4 Us Community Outreach | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 406 Lincoln St, Belmont, NC 28012-3045 | 2019-02-19 |
| 1871059444 | Believing Everyone Succeeds Together | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 323 Shady Grove Rd, Kings Mtn, NC 28086-9671 | 2019-02-19 |
| 1740744283 | Tri Plex Industries Corp | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 9635 Southern Pine Blvd Ste 154, Charlotte, NC 28273-5564 | 2019-01-29 |
| 1316415037 | Igr Collaborations | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 212 Pine Ridge Dr, Roanoke Rapids, NC 27870-6832 | 2018-11-12 |
| 1164924940 | David Douglas Whitfield | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5342 Us Highway 301 North, Micro, NC 27555 | 2018-03-07 |
| 1710489976 | Moravian Enterprises, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 122 North Elm St., Suite 810, Greensboro, NC 27401 | 2018-03-05 |
| 1659897833 | Shelby Day Program | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 621 S Dekalb St Ste A, Shelby, NC 28150-6189 | 2017-08-18 |
| Find all providers with the same taxonomy | ||||
| City | FUQUAY VARINA |
| Zip Code | 27526 |
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| 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.