SELF DETERMINATION, LLC (NPI# 1972954113) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972954113 |
| Entity Type | Organization |
| Organization Name | SELF DETERMINATION, LLC |
| Practice Address |
423 Millsap Rd Shelby NC 28150 |
| Mailing Address |
423 Millsap Rd Shelby NC 28150-9634 |
| Practice Telephone | 7046006092 |
| Mailing Telephone | 7046006092 |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2018-08-10 |
| Authorized Official Name | MRS. ANNE JEFFRIES (OWNER) |
| Authorized Official Telephone | 9802978964 |
| Authorized Official Credential | BC-HSP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 320800000X | Community Based Residential Treatment Facility, Mental Illness | 623-203 | NC | Residential Treatment Facilities |
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | NC | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | H2020 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568852424 | Self Determination, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 1023 Bramblewood Ct Ne, Lenoir, NC 28645-3835 | 2015-01-30 |
| Street Address |
423 MILLSAP RD |
| City | SHELBY |
| State | NC |
| Zip Code | 28150 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154981652 | Benjamin Caple | Dentist | 139 W Ross Grove Rd, Shelby, NC 28150 | 2019-06-17 |
| 1003471103 | Anne Marie Lackey | Physician Assistant | 215 Stacey Street, Lawndale, NC 28150 | 2019-05-03 |
| 1174001937 | Allstate Medical Equipment & Supplies | Durable Medical Equipment & Medical Supplies | 607 W Grover St, Shelby, NC 28150 | 2018-08-03 |
| 1013494970 | Shannon Bumgardner Standish | Nurse Practitioner | 1019 N Lafayette Street, Suite 1, Shelby, NC 28150 | 2018-07-24 |
| 1205323078 | Focused Care, Inc | Community/Behavioral Health | 834 Churchill Dr, Shelby, NC 28150 | 2018-04-17 |
| 1508373507 | Janelle Marie Velasco | Acupuncturist | 115 E Sumter St, Shelby, NC 28150 | 2017-12-29 |
| 1902344666 | Georgette Johnson | Durable Medical Equipment & Medical Supplies | 607 West Grover Street, Shelby, NC 28150 | 2017-02-02 |
| 1457703126 | Sweet Caroline Assisted Living LLC | Assisted Living Facility | 110 Greene Drive, Shelby, NC 28150 | 2016-07-06 |
| 1306217666 | Living Family Supportive Services | Clinic/Center | 2538 West Dixon Blvd., Shelby, NC 28150 | 2015-10-13 |
| 1306244223 | Mary Jean Elder | Counselor | 809 N Lafayette St Ste A, Shelby, NC 28150 | 2014-12-09 |
| Find all providers in zip 28150 | ||||
| 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 |
|---|---|---|---|---|
| 1871742361 | New Genesis Residential Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 3020 Arnold Dr, Shelby, NC 28152-7504 | 2008-09-09 |
| 1811034531 | Point Fof Love and Grace Inc | Residential Treatment Facility, Emotionally Disturbed Children | 1734 Stony Point Rd, Shelby, NC 28150-9600 | 2007-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023617255 | Creative Helping Hands LLC | Residential Treatment Facility, Emotionally Disturbed Children | 478 Green Lake Rd, Rockingham, NC 28379-7850 | 2020-10-19 |
| 1083237986 | Revive Housing LLC | Residential Treatment Facility, Emotionally Disturbed Children | 210 Sunset Dr Apt 615, Salisbury, NC 28147-7147 | 2020-05-26 |
| 1457998627 | Re Health Group | Residential Treatment Facility, Emotionally Disturbed Children | 1102 Groves St, Kings Mountain, NC 28086-2232 | 2019-12-05 |
| 1821631532 | Marquita Latrice Walls | Residential Treatment Facility, Emotionally Disturbed Children | 1565 Longbranch Rd, Grover, NC 28073-9599 | 2019-10-25 |
| 1699233866 | A Brighter Path LLC | Residential Treatment Facility, Emotionally Disturbed Children | 120 Jetter Rd, Grover, NC 28073-9687 | 2019-03-06 |
| 1821562224 | Carter Clinic, Pa | Residential Treatment Facility, Emotionally Disturbed Children | 703 W 3rd Ave Bldg A, Red Springs, NC 28377-1524 | 2019-01-18 |
| 1659842607 | Gervonia Robinson | Residential Treatment Facility, Emotionally Disturbed Children | 1714 Aster Ln, Gastonia, NC 28054-8303 | 2018-12-16 |
| 1679058440 | Miracle Houses Inc | Residential Treatment Facility, Emotionally Disturbed Children | 7827 Kerrybrook Cir, Charlotte, NC 28214-2513 | 2018-09-27 |
| 1174048078 | A Safe Place Community Housing, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 2049 Highland St, Charlotte, NC 28208-4909 | 2017-08-11 |
| 1104346881 | Inspiration for Us | Residential Treatment Facility, Emotionally Disturbed Children | 1205 W Mountain St, Kernersville, NC 27284-2173 | 2017-06-22 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on SELF DETERMINATION, LLC.
| 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.