BRUSHY MOUNTAIN GROUP HOMES INC NPI 1205940129

NPI Information

  • NPI: 1205940129
  • Provider Name: BRUSHY MOUNTAIN GROUP HOMES, INC
  • Classification: Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320600000X
  • Entity Type: Organization
  • Doing Business As: HOLLY HILLS GROUP HOME
  • Address: 179 HOLLY BROOK ST
    NORTH WILKESBORO, NC
    ZIP 28659
  • Phone: (336) 670-9352

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NPI Details

BRUSHY MOUNTAIN GROUP HOMES, INC is a residential treatment facility, intellectual and/or developmental disabilities in North Wilkesboro, NC. The provider is a residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently. BRUSHY MOUNTAIN GROUP HOMES, INC NPI is 1205940129. The provider is registered as an organization entity type.
The provider Is Doing Business As Holly Hills Group Home.

The provider's business location address is:

179 HOLLY BROOK ST
NORTH WILKESBORO, NC
ZIP 28659-754
Phone: (336) 670-9352
Fax: (336) 838-3490

The provider's authorized official is Shelley Darlene Gamble .
The authorized official title is Executive Director and has the following contact phone number (336) 838-3789.

The enumeration date for this NPI number is 8/18/2006 and was last updated on 6/19/2008.

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
1320600000XResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesMHL097045NORTH CAROLINAYes

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
17804482MEDICAIDNORTH 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: 11/21/2025

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