PELHAM SUPPORTIVE SERVICES (NPI# 1710144738) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710144738 |
| Entity Type | Organization |
| Organization Name | PELHAM SUPPORTIVE SERVICES |
| Other Organization Name | PELHAM GROUP HOME #2 |
| Practice Address |
4906 Redwood Dr Fayetteville NC 28304-4213 |
| Mailing Address |
949 Country Club Dr Fayetteville NC 28301-2907 |
| Practice Telephone | 9108262990 |
| Mailing Telephone | 9106306757 |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2008-05-19 |
| Authorized Official Name | MILDRED WILSON (DIRECTOR) |
| Authorized Official Telephone | 9106306757 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | MHL-026-824 | NC | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| PELHAM GROUP HOME #2 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770924482 | Pelham Supportive Services | Community Based Residential Treatment Facility, Mental Illness | 5740 Longview Dr, Fayetteville, NC 28306-8567 | 2013-07-10 |
| 1649558933 | Pelham Supportive Services | Community/Behavioral Health | 315 A West Broad Street, St Pauls, NC 28384-1535 | 2011-08-03 |
| 1053626135 | Pelham Supportive Services | Community Based Residential Treatment Facility, Mental Illness | 2226 Memory St, Fayetteville, NC 28304-5827 | 2010-08-12 |
| 1760544712 | Pelham Supportive Services | Community Based Residential Treatment Facility, Mental Illness | 1712 Shiloh Dr, Fayetteville, NC 28304-4027 | 2006-12-15 |
| 1225339054 | Pelham Supportive Services | Community Based Residential Treatment Facility, Mental Illness | 949 Country Club Dr, Fayetteville, NC 28301-2907 | 2010-11-10 |
| Street Address |
4906 REDWOOD DR |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28304-4213 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598301061 | Coast To Coast Bilingual Counseling | Social Worker | 910 Hope Mills Road, Fayetteville, NC 28304 | 2019-11-20 |
| 1811530561 | Frances L. Hurst | Technician | 6732 Carloway Dr, Fayetteville, NC 28304 | 2019-10-25 |
| 1538717764 | Rose Mary A O'conner | Technician | 3530 Madison Ave, Fayetteville, NC 28304 | 2019-08-30 |
| 1932756087 | Sally Frances Jones | Technician | 2053 Mango Circle, Fayetteville, NC 28304 | 2019-08-23 |
| 1326528803 | Jeneen Yvette Townsend | Counselor | 2671 Adams Lake Dr Apt F, Fayetteville, NC 28304 | 2018-08-15 |
| 1780179580 | Ma Cornelia Villavicencio Leano | Nurse Practitioner | 3081 Stone Carriage Cir Apt Z, Fayetteville, NC 28304 | 2018-06-25 |
| 1861986267 | Pediatric After Hours Care of Fayetteville | Pediatrics | 556 Sandhurst Drive, Fayetteville, NC 28304 | 2018-06-19 |
| 1700386133 | Good Night Medical of Ohio, LLC | Durable Medical Equipment & Medical Supplies | 405 Owen Dr Ste 202, Fayetteville, NC 28304 | 2018-02-12 |
| 1003321365 | Valleygate Dental Surgery Center of Fayetteville, LLC | Dentist | 2038 Litho Place, Fayetteville, NC 28304 | 2017-12-08 |
| 1871004663 | The Salt Project | Marriage & Family Therapist | 1611-b Owen Dr., Fayetteville, NC 28304 | 2017-10-19 |
| Find all providers in zip 28304 | ||||
| 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 |
|---|---|---|---|---|
| 1548793441 | Stonebridge Family Counseling | Community Based Residential Treatment Facility, Mental Illness | 209 Edison St E, Fayetteville, TN 37334-3007 | 2017-04-06 |
| 1366846404 | The Loving Home,inc. #6 | Community Based Residential Treatment Facility, Mental Illness | 1903 Bridger St, Fayetteville, NC 28301-3913 | 2014-10-17 |
| 1063814127 | Joyoflivingprogramsforyouthandfamiliesnetwork | Community Based Residential Treatment Facility, Mental Illness | 170 Hilo Rd, 1803 Hwy 92 N, Fayetteville, GA 30215-2402 | 2014-09-20 |
| 1770924482 | Pelham Supportive Services | Community Based Residential Treatment Facility, Mental Illness | 5740 Longview Dr, Fayetteville, NC 28306-8567 | 2013-07-10 |
| 1003167586 | Upward Process Inc. | Community Based Residential Treatment Facility, Mental Illness | 568 Alleghany Rd, Fayetteville, NC 28304 | 2012-09-25 |
| 1629369012 | New Horizons Group Home | Community Based Residential Treatment Facility, Mental Illness | 3117 Dyke St, Fayetteville, NC 28306-2808 | 2011-04-20 |
| 1053626135 | Pelham Supportive Services | Community Based Residential Treatment Facility, Mental Illness | 2226 Memory St, Fayetteville, NC 28304-5827 | 2010-08-12 |
| 1295960326 | Precious Haven Inc. | Community Based Residential Treatment Facility, Mental Illness | 7762 Hazelwood Ave, Fayetteville, NC 28314-6246 | 2009-05-19 |
| 1710122114 | Melrose Center | Community Based Residential Treatment Facility, Mental Illness | 421 Maiden Ln Ste 207, Fayetteville, NC 28301-5055 | 2008-12-14 |
| 1720276868 | Coastal Behavior Health Services, Inc. | Community Based Residential Treatment Facility, Mental Illness | 806 Stamper Rd Ste 201, Fayetteville, NC 28303-4100 | 2007-10-12 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 28304 |
Please comment or provide details below to improve the information on PELHAM SUPPORTIVE SERVICES.
| 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.