PHOENIX BRIDGE COMMUNITY SUPPORT (NPI# 1508045998) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508045998 |
| Entity Type | Organization |
| Organization Name | PHOENIX BRIDGE COMMUNITY SUPPORT |
| Practice Address |
814 Bradley St Burlington NC 27215-6806 |
| Mailing Address |
909 A South Main Street Burlington NC 27215-5756 |
| Practice Telephone | 3362228522 |
| Practice Fax Number | 3362228533 |
| Mailing Telephone | 3362228522 |
| Mailing Fax Number | 3362228533 |
| Enumeration Date | 2007-11-01 |
| Last Update Date | 2007-11-01 |
| Authorized Official Name | MISS WENDY RENEE JONES (PROGRAM DIRECTOR) |
| Authorized Official Telephone | 3362228522 |
| Is Organization Subpart | Y |
| Parent Organization Name | PHOENIX BRIDGE GROUP HOME, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | MHL-001-121 | NC | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 6603578 | 05 |
| Street Address |
814 BRADLEY ST |
| City | BURLINGTON |
| State | NC |
| Zip Code | 27215-6806 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700178498 | Alamance Homes | Community Based Residential Treatment Facility, Mental Illness | 814 Bradley St, Burlington, NC 27215-6806 | 2011-05-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235748708 | Svetlana Nepocatych | Dietitian, Registered | 542 Spaulding St, Burlington, NC 27215 | 2020-07-30 |
| 1992341382 | Gracepoint Recovery Services | Counselor | The Gregory Business Center, 154 Huffman Mill Roal, Burlington, NC 27215 | 2019-11-21 |
| 1336797331 | Kelly Elizabeth Fleming | Preventive Medicine | Stallings-evans Sports Medicine Center, 91 Stadium Drive, Chapel Hill, NC 27215 | 2019-09-03 |
| 1861911968 | Michael Frey | Pharmacist | 2344 South Church St, Burlington, NC 27215 | 2017-09-11 |
| 1174043822 | Comfort Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 1244 Plaza Dr, Burlington, NC 27215 | 2017-06-23 |
| 1811417561 | Burlington Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 1244 Plaza Drive, Burlington, NC 27215 | 2017-06-23 |
| 1912459132 | Herb Mccandless Jr. | Non-emergency Medical Transport (VAN) | 4412 Dogwood Rd, Burlington, NC 27215 | 2016-11-04 |
| 1023479623 | Alpha Diagnostics, LLC | Clinical Medical Laboratory | 3015 South Church St, Burlington, NC 27215 | 2016-03-10 |
| 1669720819 | Lucy Wessinger Menefee | Registered Nurse | Unc Nephrology and Hypertension, 3325 Garden Road, Burlington, NC 27215 | 2012-08-20 |
| 1154685402 | Sheryl Harper | Social Worker | 2815 North Church Street, Burlington, NC 27215 | 2012-07-02 |
| Find all providers in zip 27215 | ||||
| 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 |
|---|---|---|---|---|
| 1154560050 | Susie's Place | Residential Treatment Facility, Emotionally Disturbed Children | 724 Askew St, Burlington, NC 27215-2202 | 2009-02-17 |
| 1477709434 | Vince Marley | Residential Treatment Facility, Emotionally Disturbed Children | 219 Albany St, Burlington, NC 27215-7249 | 2008-08-11 |
| 1265690390 | Never Give Up Community Services | Residential Treatment Facility, Emotionally Disturbed Children | 303 Trail One, Burlington, NC 27215-5535 | 2008-05-27 |
| 1932372083 | White Oaks Residential Services, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 5908 S Nc Highway 49, Burlington, NC 27215-9621 | 2008-04-09 |
| 1568634053 | A New Vision of Alamance,llc | Residential Treatment Facility, Emotionally Disturbed Children | 103 Jefferson St, Burlington, NC 27217-1338 | 2008-03-25 |
| 1144402926 | Lifecycles of Alamance/caswell Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1865 N Nc Highway 62, Burlington, NC 27217-8327 | 2007-12-03 |
| 1033398425 | Phoenix Bridge Community Services | Residential Treatment Facility, Emotionally Disturbed Children | 5450 Patillo Church Rd, Burlington, NC 27217-8553 | 2007-11-01 |
| 1942489331 | Youth Train Ventures | Residential Treatment Facility, Emotionally Disturbed Children | 3309b North Carolina Highway 49 North, Burlington, NC 27217 | 2007-11-01 |
| 1013100031 | Redeem House, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 2711 Maple Ave, Burlington, NC 27215-7117 | 2007-08-22 |
| 1417155763 | Youth Builders, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 2423 Morningside Dr, Burlington, NC 27217-3147 | 2007-07-09 |
| Find all providers in BURLINGTON | ||||
| City | BURLINGTON |
| Zip Code | 27215 |
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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.