EASON COURT GROUP HOME LLC #2 NPI 1003353475

NPI Information

NPI: 1003353475
Provider Name: EASON COURT GROUP HOME LLC #2
Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
Entity Type: Organization

CLIA Number: 34D2064682

Address:
124 GREGORY MNR
YOUNGSVILLE, NC
ZIP 27596
Phone: (919) 556-5355
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EASON COURT GROUP HOME LLC #2 is a community based residential treatment facility mental illness in Youngsville, NC. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. EASON COURT GROUP HOME LLC #2 NPI is 1003353475. The provider is registered as an organization entity type.

The provider's business location address is:

124 GREGORY MNR
YOUNGSVILLE, NC
ZIP 27596-614
Phone: (919) 556-5355
Fax: (866) 285-8824

The provider's authorized official is Sonja Denise Williams .
The authorized official title is ASSISTANT DIRECTORDirector and has the following contact phone number (571) 288-4144.

The CLIA number assigned to this NPI record is 34D2064682 - other - adult care home with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/24/2017 and was last updated on 1/24/2017.

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	Taxonomy Specialization	License Number	License State	Primary
1	320800000X	Community Based Residential Treatment Facility, Mental Illness		MHL 035 050	NORTH CAROLINA	Yes
2	320800000X	Community Based Residential Treatment Facility, Mental Illness		MHL 035 029	NORTH CAROLINA	No

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	7804575	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

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