MRS. STEHANIE D WALL (NPI# 1083045306) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083045306 |
| Entity Type | Individual |
| Full Name | MRS. STEHANIE D WALL |
| Practice Address |
1357 Wayside Rd Raeford NC 28376-6513 |
| Mailing Address |
3204 High Plains Dr Hope Mills NC 28348-5726 |
| Practice Telephone | 9105652139 |
| Mailing Telephone | 9106748605 |
| Enumeration Date | 2013-12-12 |
| Last Update Date | 2015-01-09 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | MHL-047-152 | NC | Residential Treatment Facilities |
| N | 347C00000X | Private Vehicle | 27-0962043 | SC | Transportation Services |
| N | 171M00000X | Case Manager/Care Coordinator | 27-0962043 | SC | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | 1083045306 | 05 | |
| SC | STATE FUND | 1083045306 | 01 |
| Street Address |
1357 WAYSIDE RD |
| City | RAEFORD |
| State | NC |
| Zip Code | 28376-6513 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578185104 | Elite Supply Services, Inc. | Durable Medical Equipment & Medical Supplies | 2148 Bus-us 401, Raeford, NC 28376 | 2020-05-18 |
| 1205485695 | Brenda P Gregorio | Technician | 297 Gregorios Ln, Raeford, NC 28376 | 2019-09-09 |
| 1083197115 | Jennifer Picerno Bowyer | Nurse Practitioner | 929 Prospect Ave., Raeford, NC 28376 | 2018-09-14 |
| 1730694746 | Embassy Health Network | Counselor | 2148 Hwy 401 Business, Raeford, NC 28376 | 2017-12-13 |
| 1508398991 | Rockfish Pharmacy Inc | Pharmacy | 221 Flagstone Lane, Raeford, NC 28376 | 2017-04-03 |
| 1205281235 | William Fiebig | Nurse Practitioner | Hoke Hospital, 210 Medical Pavilion Drive, Raeford, NC 28376 | 2016-04-27 |
| 1306200647 | Tia Hart Community Recovery Program | Community/Behavioral Health | 2188 A Us 401 Business, Raeford, NC 28376 | 2016-04-13 |
| 1508240631 | Integrated Mental Health Services Agency Inc | Community/Behavioral Health | 2188-a Hwy 401 Business, Raeford, NC 28376 | 2015-07-18 |
| 1649658287 | Divine Medical Supplies Inc | Durable Medical Equipment & Medical Supplies | 320 Birch St, Raeford, NC 28376 | 2015-05-15 |
| 1992192298 | David Abdulhaqq | Counselor | 225 Aggies Lane, Raeford, NC 28376 | 2015-04-24 |
| Find all providers in zip 28376 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053664227 | Southerland Consulting Group Services, Inc | Community Based Residential Treatment Facility, Mental Illness | 111 W Elwood Ave, Raeford, NC 28376-2801 | 2012-10-24 |
| 1881869246 | Good Deeds | Community Based Residential Treatment Facility, Mental Illness | 381 Northwoods Dr, Raeford, NC 28376-6217 | 2008-04-28 |
| 1578734398 | Regina's Touch | Community Based Residential Treatment Facility, Mental Illness | 1306 Mcneill Farm Rd, Raeford, NC 28376 | 2008-03-19 |
| 1548472434 | Premier Healthcare Services Inc | Community Based Residential Treatment Facility, Mental Illness | 1892 Turnpike Road, Raeford, NC 28376 | 2007-05-04 |
| 1073736013 | The Mental Health Association In North Carolina, Inc | Community Based Residential Treatment Facility, Mental Illness | 400 W. Eigth St, Raeford, NC 28376 | 2007-04-10 |
| 1619044682 | Dedicated Family Inspirations, LLC | Community Based Residential Treatment Facility, Mental Illness | 1820 Silver City St, Raeford, NC 28376-8604 | 2006-11-29 |
| 1164711446 | Preferred Care Inc | Community Based Residential Treatment Facility, Mental Illness | 318 Harris Ave, Raeford, NC 28376-3110 | 2011-04-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366041667 | Jalisa Jackson | Community Based Residential Treatment Facility, Mental Illness | 11413 Mangla Dr, Charlotte, NC 28214-8885 | 2020-10-19 |
| 1245837061 | Bliss Haven Group LLC | Community Based Residential Treatment Facility, Mental Illness | 2442 Sandhurst Ct, Gastonia, NC 28054-2738 | 2020-10-05 |
| 1386259265 | Nevaehs Caring Hands | Community Based Residential Treatment Facility, Mental Illness | 2509 Dalton Rd, Rocky Mount, NC 27803-4721 | 2020-09-09 |
| 1588279442 | C & C Homecare, LLC | Community Based Residential Treatment Facility, Mental Illness | 5119 Holdens Cross Rd, Wilson, NC 27893-8253 | 2020-09-08 |
| 1801409859 | Destiny & Miracle LLC | Community Based Residential Treatment Facility, Mental Illness | 1024 Houston St, Gastonia, NC 28052-1632 | 2020-08-28 |
| 1699329433 | Fresh Start Today Inc | Community Based Residential Treatment Facility, Mental Illness | 3707 Roseheim Ct, Greensboro, NC 27405-4867 | 2019-07-30 |
| 1003460833 | Care-in-full | Community Based Residential Treatment Facility, Mental Illness | 1338 Sharp Ridge Rd, Greensboro, NC 27406-8597 | 2019-07-30 |
| 1366001976 | Foundation of Hope, Inc. | Community Based Residential Treatment Facility, Mental Illness | 119 Grice Road, Chadbourn, NC 28431-6709 | 2019-06-07 |
| 1558927590 | Tall Family Services, Inc. | Community Based Residential Treatment Facility, Mental Illness | 1915 Hasty Rd, Marshville, NC 28103-0029 | 2019-05-15 |
| 1174187868 | Stepping Stone Services Inc. | Community Based Residential Treatment Facility, Mental Illness | 2720 White Oak Ln, Kannapolis, NC 28083-7256 | 2019-04-28 |
| Find all providers with the same taxonomy | ||||
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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.