FULL POTENTIAL LLC NPI 1083747828

NPI Information

NPI: 1083747828
Provider Name: FULL POTENTIAL, LLC

Other Name: FULL POTENTIAL AT PEMBROKE

Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
Entity Type: Organization
Address:
177 CARDINAL AVE
LUMBERTON, NC
ZIP 28360
Phone: (910) 670-1989
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FULL POTENTIAL, LLC is a community based residential treatment facility mental illness in Lumberton, NC. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. FULL POTENTIAL, LLC NPI is 1083747828. The provider is registered as an organization entity type.
The provider Other Name Is Full Potential At Pembroke.

The provider's business location address is:

177 CARDINAL AVE
LUMBERTON, NC
ZIP 28360-386
Phone: (910) 670-1989

The provider's authorized official is Jerome Johnson .
The authorized official title is Director and has the following contact phone number (910) 670-1989.

The enumeration date for this NPI number is 3/13/2007 and was last updated on 8/22/2020.

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-078-188	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	6604094	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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