1164578886 NPI number — COLUMBUS GROUP HOMES, INC.

Table of content: (NPI 1164578886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164578886 NPI number — COLUMBUS GROUP HOMES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBUS GROUP HOMES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164578886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 N FRANKLIN ST
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
WHITEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28472-2735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-640-1557
Provider Business Mailing Address Fax Number:
910-640-0814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 N FRANKLIN ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
WHITEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28472-2735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-640-1557
Provider Business Practice Location Address Fax Number:
910-640-0814
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROWELL
Authorized Official First Name:
SELENA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
910-640-1557

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  MHL024014 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320800000X , with the licence number: MHL024017 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3408591 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301088B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7802395 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7802400 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7802403 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301088 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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