PELHAM SUPPORTIVE SERVICES (NPI# 1770924482) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770924482 |
| Entity Type | Organization |
| Organization Name | PELHAM SUPPORTIVE SERVICES |
| Other Organization Name | PELHAM GROUP HOME #3 |
| Practice Address |
5740 Longview Dr Fayetteville NC 28306-8567 |
| Mailing Address |
949 Country Club Dr Fayetteville NC 28301-2907 |
| Practice Telephone | 9104254168 |
| Practice Fax Number | 9104888823 |
| Mailing Telephone | 9104887633 |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2013-07-11 |
| Authorized Official Name | MILDRED WILSON (DIRECTOR) |
| Authorized Official Telephone | 9104887633 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | MHL-026-854 | NC | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 7806041 | 05 |
| Other Name | Type Code |
|---|---|
| PELHAM GROUP HOME #3 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1710144738 | Pelham Supportive Services | Community Based Residential Treatment Facility, Mental Illness | 4906 Redwood Dr, Fayetteville, NC 28304-4213 | 2008-05-19 |
| 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 |
5740 LONGVIEW DR |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28306-8567 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689062473 | Macbill,inc. | Community Based Residential Treatment Facility, Mental Illness | 5740 Longview Dr, Fayetteville, NC 28306-8567 | 2014-12-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013539501 | Lauren Lockhart | Pharmacist | 5106 Nc-87 #100, Fayetteville, NC 28306 | 2020-05-07 |
| 1528687472 | Edutherapy Connection LLC | Occupational Therapist | 3518 Grenedine Dr, Fayetteville, NC 28306 | 2020-04-10 |
| 1245708213 | Catherine H Cox | Speech-Language Pathologist | Southeastern Communication and Swallowing Specialists, 3530 Boone Trail, Fayetteville, NC 28306 | 2018-11-08 |
| 1720446776 | Wal-mart Store East, Lp | Technician/Technologist | 2820 Gillespie St., Fayetteville, NC 28306 | 2016-02-05 |
| 1720460017 | Sridhar Gottipati | Pharmacist | 10072 Southern Ave., Fayetteville, NC 28306 | 2015-06-23 |
| 1942687900 | St Marys Hca of South Carolina | Clinic/Center | 2603 Cumberland Gap Drive, Suite 203, Fayetteville, NC 28306 | 2015-04-29 |
| 1649696204 | Kathryn Dries | Nurse Practitioner | 7496 Rockfish Road, Fayetteville, NC 28306 | 2014-03-06 |
| 1508288218 | Teresa Mcneill | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3608 Pickerel St, Fayetteville, NC 28306 | 2014-01-15 |
| 1740535715 | Harris Teeter, LLC | Pharmacy | 3050 Traemoor Village Dr, Fayetteville, NC 28306 | 2012-07-17 |
| 1184928848 | Hanora Medical Center, Pllc | Internal Medicine | 2620 Owen Dr, Fayetteville, NC 28306 | 2011-01-10 |
| Find all providers in zip 28306 | ||||
| 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 |
| 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 |
| 1710144738 | Pelham Supportive Services | Community Based Residential Treatment Facility, Mental Illness | 4906 Redwood Dr, Fayetteville, NC 28304-4213 | 2008-05-19 |
| 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 | 28306 |
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.