ECHO FARMS GROUP HOME Full NPI Record 1003021874

Intermediate Care Facility, Mentally Retarded in Wilmington, NC

Complete NPI Dataset

The following table represents the complete NPI 1003021874 dataset for Echo Farms Group Home in 220 DORCHESTER PL WILMINGTON, NC 28412. The data table includes a list of all field names, values and definitions of the complete NPI record. The NPI dataset is available for download in CSV format using the "Download NPI" button below at the end of the table.

Name Value Definition
NPI1003021874The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameLIFETIME RESOURCES, INC.The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization NameECHO FARMS GROUP HOMEOther name by which the organization provider is or has been known.
Provider Other Organization Name Type Code5Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address1316 S. 16TH STREETThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City NameWILMINGTONThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameNCThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code284016422The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number9107621189The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number9107621301The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address220 DORCHESTER PLThe first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameWILMINGTONThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameNCThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code284127324The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number9107621189The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number9107621301The fax number associated with the location address of the provider being identified.
Provider Enumeration Date5/14/2007The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date7/7/2017The date that a record was last updated or changed.
Authorized Official Last NameTHACKER, JR.The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameROBERTThe first name of the authorized official.
Authorized Official Middle NameT.The middle name of the authorized official.
Authorized Official Title or PositionEXECUTIVE DIRECTORThe title or position of the authorized official.
Authorized Official Telephone Number9107621189The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1320600000XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 13406452The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1NCThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1N
Healthcare Provider Taxonomy Code 2315P00000X
Provider License Number 23406452The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2NCThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2Y
Other Provider Identifier 13406452Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 105Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1NC
Is Organization SubpartN
Authorized Official Name Prefix TextDR.
Authorized Official Credential TextPH.D.