DWAYNE'S EXTENDED FAMILY SERVICES, INC. (NPI# 1831256858) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831256858 |
| Entity Type | Organization |
| Organization Name | DWAYNE'S EXTENDED FAMILY SERVICES, INC. |
| Practice Address |
1421 Walnut St Greensboro NC 27405-6648 |
| Mailing Address |
1215 Bales Chapel Rd Jamestown NC 27282-9149 |
| Practice Telephone | 3366383494 |
| Practice Fax Number | 3366383494 |
| Mailing Telephone | 3366383494 |
| Mailing Fax Number | 3366383494 |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DWAYNE TRIPP (OWNER) |
| Authorized Official Telephone | 3366383494 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | MHL-041-676 | NC | Residential Treatment Facilities |
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | MHL-041-627 | NC | Residential Treatment Facilities |
| Street Address |
1421 WALNUT ST |
| City | GREENSBORO |
| State | NC |
| Zip Code | 27405-6648 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477038727 | Miya Jackson | Behavior Technician | 2308 Golden Gate Dr, Apt G, Greensboro, NC 27405 | 2018-10-02 |
| 1821576299 | Woodrow Eric Bradley | Day Training/Habilitation Specialist | 1403 Woocbriar Ave, Greensboro, NC 27405 | 2018-07-30 |
| 1922593094 | Constance Foushee | Nurse Practitioner | 1100 E. Wendover, Greensboro, NC 27405 | 2018-06-29 |
| 1760972434 | Ayana Linette Holland | Home Health Aide | 1417 Old Hickory Dr, Greensboro, NC 27405 | 2018-05-17 |
| 1790294700 | G. Antoine Gray | Specialist | 2100 Phillips Avenue, Suite B, Greensboro, NC 27405 | 2017-09-21 |
| 1306375910 | Wendy Carisa Boger | Registered Nurse | 1100 East Wendover Avenue, Greensboro, NC 27405 | 2017-06-07 |
| 1659827715 | Changing Paths Counseling Center Pllc | Community/Behavioral Health | 1600 E Wendoer Ave., Suite C, Greensboro, NC 27405 | 2016-08-29 |
| 1295187896 | Amanda Kirby Counseling, PC | Counselor | 1175 Revolution Mill Drive, Suite 29-2, Greensboro, NC 27405 | 2016-07-07 |
| 1780049429 | Pta | Residential Treatment Facility, Physical Disabilities | 1900 Sheldon Road, Greensboro, NC 27405 | 2015-12-23 |
| 1841655644 | Amaya Nicole Hardy | Counselor | 1600r E Wendover Ave Ste R, Greensboro, NC 27405 | 2015-12-21 |
| Find all providers in zip 27405 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568693778 | Zenith Providers | Residential Treatment Facility, Emotionally Disturbed Children | 3802 Broadacres Dr, Greensboro, NC 27407-6502 | 2009-08-05 |
| 1013148519 | Zenith Providers, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 7 Kelley Ct, Greensboro, NC 27401-4679 | 2009-07-31 |
| 1811125669 | Hope House Restoration Center | Residential Treatment Facility, Emotionally Disturbed Children | 4102 Cornerrock Dr, Greensboro, NC 27406-8586 | 2009-06-30 |
| 1952539314 | Keystone Youth Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 4411 Belfield Dr, Greensboro, NC 27405-6313 | 2009-06-24 |
| 1548497795 | Fresh Start Service Support | Residential Treatment Facility, Emotionally Disturbed Children | 4708 Meadowcroft Rd, Greensboro, NC 27406-8085 | 2009-06-15 |
| 1396970521 | Safe-haven House II, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 4202 Old Liberty Place, Safe-haven House II, LLC, Greensboro, NC 27406-7218 | 2009-05-18 |
| 1407090392 | New Beginnings | Residential Treatment Facility, Emotionally Disturbed Children | 5709 Northlake Dr, Greensboro, NC 27410-2630 | 2009-04-23 |
| 1720222615 | Garden Lakes | Residential Treatment Facility, Emotionally Disturbed Children | 3824 Yanceyville St, Greensboro, NC 27405-3348 | 2009-04-23 |
| 1588801294 | Victory House | Residential Treatment Facility, Emotionally Disturbed Children | 804 Quail Cove Ct, Greensboro, NC 27406-8082 | 2009-01-16 |
| 1215181953 | New Life Family Service | Residential Treatment Facility, Emotionally Disturbed Children | 112 Corliss St, Greensboro, NC 27406-5208 | 2008-11-07 |
| Find all providers in GREENSBORO | ||||
| City | GREENSBORO |
| Zip Code | 27405 |
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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.