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LINDA SHORTS HOME NPI 1316003668


NPI Information

NPI: 1316003668
Provider Name: LINDA SHORTS HOME
Classification: Clinic/Center - 261QD1600X
Entity Type: Organization

Specialization: Developmental Disabilities

CLIA Number: 34D2133137

Address:
106 GRANTHAM LN
JACKSONVILLE, NC
ZIP 28546
Phone: (910) 455-4480
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LINDA SHORTS HOME is a developmental disabilities clinic center in Jacksonville, NC. The provider is an entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). LINDA SHORTS HOME NPI is 1316003668. The provider is registered as an organization entity type.

The provider's business location address is:

106 GRANTHAM LN
JACKSONVILLE, NC
ZIP 28546-150
Phone: (910) 455-4480

The provider's authorized official is Linda E Gibson .
The authorized official title is Director and has the following contact phone number (910) 455-6724.

The CLIA number assigned to this NPI record is 34D2133137 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/29/2006 and was last updated on 6/24/2015.


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
1320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesMHL067026NORTH CAROLINANo
2261QD1600XClinic/CenterDevelopmental DisabilitiesMHL067026NORTH 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
13408956MEDICAIDNORTH 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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