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MY PLACE
NPI 1023450723
Intermediate Care Facility, Intellectual Disabilities in Fayetteville, NC

Active since July 23, 2013CLIA 34D2271418 · Waiver
1050 HOGAN ST, FAYETTEVILLE, NC 28311(910) 484-3717(910) 484-1315 Get Directions Write a Review

NPPES record last updated: December 7, 2015. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About My Place NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MY PLACE (NPI 1023450723) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in Fayetteville, North Carolina and active in the NPI registry since July 2013. The organization holds a CLIA Waiver certificate valid through November 1, 2026 and lists Sera Gilmore, Administrator, as its authorized official.

NPPES Registry Identity

NPI1023450723
Entity TypeOrganization
Primary Taxonomy315P00000X
Legal Business NameMID-STATE HEALTH SYSTEMS, INC
Location Address1050 HOGAN STFayetteville, NC 28311-2340
Mailing Address3721 Legion RdHope Mills, NC 28348-8411 · (910) 484-3717 · Fax (910) 484-1315
Phone(910) 484-3717
Fax(910) 484-1315
Organization SubpartNo
Authorized OfficialSera GilmoreAdministrator · (910) 484-3717
Enumeration DateJuly 23, 2013
Last NPPES UpdateDecember 7, 2015
✔ NPI 1023450723 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyIntermediate Care Facility, Intellectual DisabilitiesNursing & Custodial Care Facilities
Taxonomy Code315P00000X
License✔ Licensed in NC · MHL-026-943
Definition
An intermediate care facility providing services for individuals with intellectual disabilities.
1050 HOGAN ST, Fayetteville, NC 28311
Open in Google Maps ↗

Other Names 1

Doing Business AsMy Place

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D2271418

My Place Group Home · Fayetteville, NC
Active · expires Nov 1, 2026
CLIA Number34D2271418
Laboratory TypeGroup Home
Certificate Effective DateNovember 2, 2024
Certificate Expiration DateNovember 1, 2026
Laboratory DirectorCheryl G. Mathews
Laboratory Phone(910) 488-8477
Laboratory LocationMy Place Group Home1050 Hogon St, Fayetteville, NC 28311
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PETERKIN & ASSOCIATES
Nursing Facility/Intermediate Care Facility
1050 HOGAN ST
FAYETTEVILLE, NC 28311
Cumberland County (910) 484-1869
SOPHIA B. PIERCE & ASSOCIATES, INC.
Intermediate Care Facility, Intellectual Disabilities
1050 HOGAN ST
FAYETTEVILLE, NC 28311
Cumberland County (910) 488-8477

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mid-State Health Systems, Inc's NPI number?

The NPI number for Mid-State Health Systems, Inc is 1023450723. It was assigned to this organization in the NPPES registry on July 23, 2013. The provider is doing business as My Place.

Where is Mid-State Health Systems, Inc located?

Mid-State Health Systems, Inc is located at 1050 Hogan St, Fayetteville, NC 28311. The listed phone number is (910) 484-3717.

What is Mid-State Health Systems, Inc's specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

Does Mid-State Health Systems, Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2271418) is associated with this NPI, valid through November 1, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mid-State Health Systems, Inc was last updated on December 7, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.