POTTER'S HOUSE OUTREACH CORPORATION (NPI# 1457682452) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457682452 |
| Entity Type | Organization |
| Organization Name | POTTER'S HOUSE OUTREACH CORPORATION |
| Practice Address |
603 Country Club Drive Fayetteville NC 28301-7686 |
| Mailing Address |
P.o. Box 26073 Fayetteville NC 28314-5017 |
| Practice Telephone | 9109045791 |
| Practice Fax Number | 9109046791 |
| Mailing Telephone | 9109045791 |
| Mailing Fax Number | 9109046791 |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2010-01-15 |
| Authorized Official Name | MR. VINCENT ROBINSON (CEO) |
| Authorized Official Telephone | 9109045791 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568622009 | Potter's House Outreach Corporation | Residential Treatment Facility, Emotionally Disturbed Children | 105 Harvest Ln, Raeford, NC 28376-6516 | 2008-06-09 |
| 1225164171 | Potter's House Outreach Corporation | Case Management | 100 Westlake Rd, Suite 104, Fayetteville, NC 28314-1660 | 2007-02-26 |
| Street Address |
603 COUNTRY CLUB DRIVE |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28301-7686 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134726219 | Jenna Michelle Odneal | Behavior Technician | 16915 Liverpool Pkwy. Suite B., Cornelius, NC 28301 | 2020-10-02 |
| 1790390094 | Jessica Shellman | Counselor | 408 Person St. Ste 103, Fayetteville, NC 28301 | 2020-09-14 |
| 1487205951 | Martha K Richardson | Technician | 720 Teachers Dr, Fayetteville, NC 28301 | 2019-09-25 |
| 1013568161 | Angela Rena Locklear | Counselor | 211 Lamon St, Fayeteville, NC 28301 | 2019-09-20 |
| 1619535747 | Teresa Wilson | Contractor | 1417 Canyionland Ct, Apt 209, Fayetteville, NC 28301 | 2019-06-04 |
| 1912461815 | Catherine Stevenson Nwogalanya | Community Health Worker | 1103 Hillsboro St., Fayetteville, NC 28301 | 2019-01-24 |
| 1811443187 | Michael Carroll | Counselor | 308 Peterson Place, Fayetteville, NC 28301 | 2016-08-28 |
| 1023499886 | Latifa Fedai | Nurse Practitioner | 380 Person Street, Fayettevill, NC 28301 | 2015-06-17 |
| 1265868939 | Aci Support Specialists | Community/Behavioral Health | 1725 Venna Drive, Fayetteville, NC 28301 | 2013-09-25 |
| 1871929547 | Aci Support Specialists | Day Training, Developmentally Disabled Services | 2820 Copenhagen Drive, Fayetteville, NC 28301 | 2013-09-25 |
| Find all providers in zip 28301 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528696796 | Faith Springs Eternal (fase), Pllc | Community/Behavioral Health | 2537 Gray Goose Loop, Fayetteville, NC 28306-3550 | 2020-04-01 |
| 1134684392 | Carolina Outreach, LLC | Community/Behavioral Health | 324 Person St, Fayetteville, NC 28301-5736 | 2019-02-01 |
| 1124591094 | Changing Places Therapeutic Center, Company | Community/Behavioral Health | 1044 Bragg Blvd Ste B, Fayetteville, NC 28301-4512 | 2019-01-03 |
| 1538632518 | Benevolent Counseling, Pllc | Community/Behavioral Health | 2929 Breezewood Ave Ste 203, Fayetteville, NC 28303-5357 | 2019-01-02 |
| 1386128031 | Alexander Youth Network | Community/Behavioral Health | 2115 Hope Mills Rd, Fayetteville, NC 28304-4256 | 2018-09-19 |
| 1811497639 | Alexander Youth Network | Community/Behavioral Health | 1608 Camden Rd, Rooms #16 & #17, Fayetteville, NC 28306-1734 | 2018-02-19 |
| 1629578851 | Jeanette Bostick | Community/Behavioral Health | 1628 Turkey Run, Fayetteville, NC 28312-7643 | 2018-02-14 |
| 1942718325 | A Mother's Pursuit, LLC | Community/Behavioral Health | 511 N Reilly Rd Ste A, Fayetteville, NC 28303-2440 | 2018-01-18 |
| 1992213771 | Deborah A Atkinson Phd Pllc | Community/Behavioral Health | 501 Executive Pl Ste B, Fayetteville, NC 28305-5391 | 2018-01-16 |
| 1841739455 | Aci Support Specialists | Community/Behavioral Health | 414 Snowhill Rd, Fayetteville, NC 28306-9073 | 2017-02-15 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 28301 |
Please comment or provide details below to improve the information on POTTER'S HOUSE OUTREACH CORPORATION.
| 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.