PEOPLE OF POTENTIAL INC NPI 1902928765

NPI Information

NPI: 1902928765
Provider Name: PEOPLE OF POTENTIAL, INC
Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
113 COURTLAND DR
JACKSONVILLE, NC
ZIP 28546
Phone: (910) 989-1224
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PEOPLE OF POTENTIAL, INC is a community based residential treatment facility, intellectual and/or developmental disabilities in Jacksonville, NC. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. PEOPLE OF POTENTIAL, INC NPI is 1902928765. The provider is registered as an organization entity type.

The provider's business location address is:

113 COURTLAND DR
JACKSONVILLE, NC
ZIP 28546-017
Phone: (910) 989-1224

The provider's authorized official is Dawn L Mccullen .
The authorized official title is Presidential and has the following contact phone number (901) 989-1224.

The enumeration date for this NPI number is 4/4/2007 and was last updated on 9/5/2012.

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		MHL067034	NORTH CAROLINA	No
2	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities		MHL067100	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	3409608	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: 11/14/2023

NPI Synchronization or Removal

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