PENTECOSTAL TEMPLE RESIDENTIAL SERVICES, INC. (NPI# 1902999568) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902999568 |
| Entity Type | Organization |
| Organization Name | PENTECOSTAL TEMPLE RESIDENTIAL SERVICES, INC. |
| Practice Address |
2753 W 5th St Greenville NC 27834-7817 |
| Mailing Address |
Po Box 983 Greenville NC 27835-0983 |
| Practice Telephone | 2527520057 |
| Practice Fax Number | 2528304094 |
| Mailing Telephone | 2527520057 |
| Mailing Fax Number | 2528304094 |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. CHRISTINA SIMS-SMITH (CLINICAL DIRECTOR) |
| Authorized Official Telephone | 2527526951 |
| Authorized Official Credential | BS, QP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | MHL-115 | NC | Residential Treatment Facilities |
| Street Address |
2753 W 5TH ST |
| City | GREENVILLE |
| State | NC |
| Zip Code | 27834-7817 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841801255 | Nicholas Mcarthur Bennett | Day Training, Developmentally Disabled Services | 302 C, Greenville, NC 27834 | 2020-08-11 |
| 1275150245 | Shelby Renee Jones | Student in an Organized Health Care Education/Training Program | East Carolina University College of Nursing, 600 Moye Blvd, Greenville, NC 27834 | 2020-06-25 |
| 1194347138 | Soban Ahmad | Student in an Organized Health Care Education/Training Program | 600 Moye Blvd., Vmc Ma Room 350. Internal Medicine Resi, Mailstop #734, Greenville, NC 27834 | 2020-05-13 |
| 1427687789 | Brandon Allen Yates | Student in an Organized Health Care Education/Training Program | 435 Clinic Drive, Greenville, NC 27834 | 2020-04-07 |
| 1144854407 | Kristen Springer Dreyfus | Marriage & Family Therapist | 2609 West Arlington Blvd Suite 106, Greenville, NC 27834 | 2020-02-26 |
| 1861038606 | Southern Surgical Outpatient Surgery Center, Pa | Clinic/Center | 2457 Emerald Place, Greenville, NC 27834 | 2019-11-26 |
| 1003460569 | Shaun Fitzpatrick | Nurse Practitioner | Physicians East, Pa 1850 W. Arlington Blvd., Greenville, NC 27834 | 2019-08-01 |
| 1649831496 | Katherine Salome Ross | Genetic Counselor, MS | 524 Moye Blvd, Greenville, NC 27834 | 2019-06-24 |
| 1477011880 | Lauren Bethune Scroggs | Counselor | 2150 West 5th Street, Health Sciences Building Mailstop 688, Greenville, NC 27834 | 2019-03-05 |
| 1669998001 | Idella's Care Home | Community/Behavioral Health | 2912 Lee Ct # 9a, Greenville, NC 27834 | 2017-08-17 |
| Find all providers in zip 27834 | ||||
| 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 |
|---|---|---|---|---|
| 1467892661 | Doretha Community Development | Residential Treatment Facility, Emotionally Disturbed Children | 3313 Brookline Ct, Greenville, NC 27834-8498 | 2013-07-02 |
| 1093968836 | A Second Chance,inc | Residential Treatment Facility, Emotionally Disturbed Children | 1209 Duce Dr, Greenville, NC 27834-6566 | 2008-10-24 |
| 1336316892 | Noacin, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 924 Ellery Dr, Greenville, NC 27834-0066 | 2008-05-14 |
| 1396927976 | Healthplus Therapeutic Services Inc | Residential Treatment Facility, Emotionally Disturbed Children | 205 Greenbriar Dr, Greenville, NC 27834-9699 | 2007-12-05 |
| 1235328881 | My Savior Family Care Home, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 3200 Briarcliff Dr, Greenville, NC 27834-4948 | 2007-10-19 |
| 1497963136 | Divine Guidance Integrative Services | Residential Treatment Facility, Emotionally Disturbed Children | 321 Scottish Ct, Greenville, NC 27858-8974 | 2007-05-18 |
| 1326254582 | Divine Guidance Integrative Services | Residential Treatment Facility, Emotionally Disturbed Children | 1306 Dusk Ct, Greenville, NC 27834-7785 | 2007-05-15 |
| 1629293592 | Dream Provider Care Services | Residential Treatment Facility, Emotionally Disturbed Children | 2272 Briley Rd, Greenville, NC 27834-8909 | 2007-04-16 |
| 1699804302 | Cascade Behavioral Treatment Services, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 325 Oak Grove Ave, Greenville, NC 27834-1124 | 2007-03-06 |
| 1720116072 | Infinity Options Residential Facility | Residential Treatment Facility, Emotionally Disturbed Children | 122 Fletcher Pl, Greenville, NC 27858-4723 | 2007-03-01 |
| Find all providers in GREENVILLE | ||||
| City | GREENVILLE |
| Zip Code | 27834 |
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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.