SELF DETERMINATION LLC NPI 1972954113

NPI Information

NPI: 1972954113
Provider Name: SELF DETERMINATION, LLC
Classification: Residential Treatment Facility, Emotionally Disturbed Children - 322D00000X
Entity Type: Organization
Address:
423 MILLSAP RD
SHELBY, NC
ZIP 28150
Phone: (704) 600-6092
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SELF DETERMINATION, LLC is a residential treatment facility emotionally disturbed children in Shelby, NC. The provider is a residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. SELF DETERMINATION, LLC NPI is 1972954113. The provider is registered as an organization entity type.

The provider's business location address is:

423 MILLSAP RD
SHELBY, NC
ZIP 28150
Phone: (704) 600-6092

The provider's authorized official is Anne Jeffries .
The authorized official title is Owner and has the following contact phone number (980) 297-8964.

The enumeration date for this NPI number is 6/29/2016 and was last updated on 12/8/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	License Number	License State	Primary
1	251S00000X	Community/Behavioral Health			No
2	320800000X	Community Based Residential Treatment Facility, Mental Illness	623-203	NORTH CAROLINA	No
3	322D00000X	Residential Treatment Facility, Emotionally Disturbed Children		NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	H2020	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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