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 | 251B00000X | Case Management | | | NORTH CAROLINA | No |
| 2 | 251T00000X | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | | | NORTH CAROLINA | No |
| 3 | 251X00000X | Supports Brokerage | | | NORTH CAROLINA | No |
| 4 | 310400000X | Assisted Living Facility | | | NORTH CAROLINA | No |
| 5 | 320600000X | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | | NORTH CAROLINA | No |
| 6 | 320700000X | Residential Treatment Facility, Physical Disabilities | | | NORTH CAROLINA | No |
| 7 | 320800000X | Community Based Residential Treatment Facility, Mental Illness | | | NORTH CAROLINA | No |
| 8 | 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | | NORTH CAROLINA | No |
| 9 | 343800000X | Secured Medical Transport (VAN) | | | NORTH CAROLINA | No |
| 10 | 343900000X | Non-emergency Medical Transport (VAN) | | | NORTH CAROLINA | No |
| 11 | 251C00000X | Day Training, Developmentally Disabled Services | | | NORTH CAROLINA | No |
| 12 | 347C00000X | Private Vehicle | | | NORTH CAROLINA | No |
| 13 | 251S00000X | Community/Behavioral Health | | | 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 | 8300841 | MEDICAID | NORTH CAROLINA | |
