THE ROSSBERRY HOME OF FAIRMONT INC NPI 1982743696

NPI Information

NPI: 1982743696
Provider Name: THE ROSSBERRY HOME OF FAIRMONT, INC

Doing Business As: STRAIGHT AHEAD COMMUNITY SUPPORT

Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
Entity Type: Organization
Address:
802 N PINE ST
LUMBERTON, NC
ZIP 28358
Phone: (910) 608-3566
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THE ROSSBERRY HOME OF FAIRMONT, INC 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. THE ROSSBERRY HOME OF FAIRMONT, INC NPI is 1982743696. The provider is registered as an organization entity type.
The provider Is Doing Business As Straight Ahead Community Support.

The provider's business location address is:

802 N PINE ST
LUMBERTON, NC
ZIP 28358-824
Phone: (910) 608-3566
Fax: (910) 608-3590

The provider's authorized official is Gloria J. Ross .
The authorized official title is Executive Director and has the following contact phone number (704) 933-3314.

The enumeration date for this NPI number is 2/6/2007 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				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	8300708	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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