MID-STATE HEALTH SYSTEMS INC NPI 1083056782

NPI Information

  • NPI: 1083056782
  • Provider Name: MID-STATE HEALTH SYSTEMS, INC
  • Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
  • Entity Type: Organization
  • Doing Business As: THOMAS S DECATUR HOME
  • CLIA Number: 34D2271409
  • Address: 7559 DECATUR DR
    FAYETTEVILLE, NC
    ZIP 28303
  • Phone: (910) 484-3717

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NPI Details

MID-STATE HEALTH SYSTEMS, INC is an intermediate care facility mentally retarded in Fayetteville, NC. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. MID-STATE HEALTH SYSTEMS, INC NPI is 1083056782. The provider is registered as an organization entity type.
The provider Is Doing Business As Thomas S Decatur Home.

The provider's business location address is:

7559 DECATUR DR
FAYETTEVILLE, NC
ZIP 28303-989
Phone: (910) 484-3717
Fax: (910) 484-1315

The provider's authorized official is Sera Gilmore .
The authorized official title is Administrator and has the following contact phone number (910) 484-3717.

The CLIA number assigned to this NPI record is 34D2271409 - other - group home with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/23/2013 and was last updated on 12/7/2015.

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
1315P00000XIntermediate Care Facility, Intellectual DisabilitiesMHL-026-944NORTH CAROLINAYes

What is NPI?

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This page was last updated on: 11/21/2025

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