PITT COUNTY GROUP HOME BOARD FOR MENTALLY RETARDED, AUTISTIC PERSONS, (NPI# 1164772489) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164772489 |
| Entity Type | Organization |
| Organization Name | PITT COUNTY GROUP HOME BOARD FOR MENTALLY RETARDED, AUTISTIC PERSONS, |
| Practice Address |
2240 Edgewater Dr Winterville NC 28590-9601 |
| Mailing Address |
Po Box 9 Grifton NC 28530-0009 |
| Practice Telephone | 2525244950 |
| Practice Fax Number | 2525243870 |
| Mailing Telephone | 2525244950 |
| Mailing Fax Number | 2525243870 |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2012-09-13 |
| Authorized Official Name | MARY GRACE BRIGHT (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2525244950 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | MHL-074-037 | NC | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 7802610 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164773065 | Pitt County Group Home Board for Mentally Retarded, Autistic Persons | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 6570 Fairway Dr, Grifton, NC 28530-0009 | 2012-10-02 |
| 1184975468 | Pitt County Group Home Board for Mentally Retarded, Autistic Persons | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 6962 Church St., Grifton, NC 28530 | 2012-09-26 |
| 1922358241 | Pitt County Group Home Board for Mentally Retarded, Autistic Persons | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4263 N Edge Rd, Ayden, NC 28513-7185 | 2012-09-13 |
| 1629328943 | Pitt County Group Home Board for Mentally Retarded, Autistic Persons | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1203 Red Banks Rd, Greenville, NC 27858-5302 | 2012-09-13 |
| 1841315132 | Pitt County Group Home Board for Mentally Retarded, Autistic Persons | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 560 West Queen St., Grifton, NC 28530-0009 | 2007-03-19 |
| Street Address |
2240 EDGEWATER DR |
| City | WINTERVILLE |
| State | NC |
| Zip Code | 28590-9601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427666130 | Domika Dunn | Non-emergency Medical Transport (VAN) | 2634 Mill Street, #3, Winterville, NC 28590 | 2020-07-20 |
| 1417490194 | Sarah Blakely | Counselor | 367 Branchwood Drive, Winterville, NC 28590 | 2016-11-29 |
| 1740671817 | Faith Lewis Hardison | Social Worker | 173 A Emily Dr., Winterville, NC 28590 | 2015-02-11 |
| 1255740932 | Kendal Williams Strickland | Pharmacist | 4240 Nc Hwy 11 South, Winterville, NC 28590 | 2014-08-07 |
| 1396152757 | Patricia Ragin | Counselor | 1200 Freeland Lane, Unit K1, Winterville, NC 28590 | 2014-07-17 |
| 1780941104 | Triniti House of Restoration | Psychiatric Residential Treatment Facility | 485 Marlboro Drive, Winterville, NC 28590 | 2012-04-23 |
| 1295003002 | Linda Peer Fleming | Psychologist | 108-d West Firetower Rd., Teacch South Hall Professional Center, Winterville, NC 28590 | 2011-12-07 |
| 1740595859 | Christina Neverte Sidrak | Pharmacist | 4211 Nc Highway 11 South, Winterville, NC 28590 | 2010-08-12 |
| 1902124993 | Dove United Counseling and Assessment Services | Counselor | 575 S. Square Drive, Apt 98, Winterville, NC 28590 | 2010-05-14 |
| 1841526407 | Kyle Dombach | Pharmacist | 4211 Winterville Parkway, Winterville, NC 28590 | 2009-11-02 |
| Find all providers in zip 28590 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952671299 | L Hubbrd Host Home | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 170 Smithonia Rd, Winterville, GA 30683-1417 | 2012-01-04 |
| 1548530884 | V Clarke Host Home | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 150 Winter Hill Dr, Winterville, GA 30683-1623 | 2012-01-04 |
| 1235281692 | Maal-care LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1200 Old Firetower Rd, Winterville, NC 28590-8447 | 2007-01-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578160552 | Residential Option Serving Adolescents, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2316 Carved Tree Ln, Charlotte, NC 28262-3154 | 2020-10-03 |
| 1649895442 | Gaynelle Bolling | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 102 Mandarin Dr, Pikeville, NC 27863-0020 | 2020-06-08 |
| 1851913966 | Johnson Enrichment Services LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 221 Foxcroft Dr, Winston Salem, NC 27103-5313 | 2020-05-12 |
| 1881230795 | Walter Jason Young Jr. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 412 Rook Rd, Charlotte, NC 28216-3199 | 2019-11-26 |
| 1750935839 | Heavenly Touch Residential Care | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4720 Baileys Lake Rd Nw Apt 204, Concord, NC 28027-8576 | 2019-07-28 |
| 1073166245 | Making Kids Matter, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 409 Hunton Forest Dr Nw, Concord, NC 28027-0186 | 2019-07-17 |
| 1891357752 | New Hope for Tomorrow LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 528 Baldwin Rd, Burlington, NC 27217-1702 | 2019-07-01 |
| 1114490877 | Brenda Gail Cannon | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3105 Vico Ter, Raleigh, NC 27610-5951 | 2019-01-05 |
| 1356813455 | Lamesha Marshall | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3335 Avalon Ave, Charlotte, NC 28208-3378 | 2018-12-31 |
| 1487131074 | Ronald Anthony Benjamin | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1594 Candace Ridge Dr, Greensboro, NC 27406-8595 | 2018-07-26 |
| Find all providers with the same taxonomy | ||||
| City | WINTERVILLE |
| Zip Code | 28590 |
Please comment or provide details below to improve the information on PITT COUNTY GROUP HOME BOARD FOR MENTALLY RETARDED, AUTISTIC PERSONS,.
| 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.