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SWAIN STREET GROUP HOME
NPI 1104939313
Residential Treatment Facility, Intellectual and/or Developmental Disabilities in North Wilkesboro, NC

Active since August 15, 2006CLIA 34D2340648 · Waiver
1224 SWAIN ST, NORTH WILKESBORO, NC 28659(336) 838-7220(336) 838-3490 Get Directions Write a Review

NPPES record last updated: June 19, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Swain Street Group Home NPPES

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

SWAIN STREET GROUP HOME (NPI 1104939313) is a healthcare organization registered as a residential treatment facility, intellectual and/or developmental disabilities in North Wilkesboro, North Carolina and active in the NPI registry since August 2006. The organization holds a CLIA Waiver certificate valid through March 19, 2028 and lists Shelley Darlene Gamble, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1104939313
Entity TypeOrganization
Primary Taxonomy320600000X
Legal Business NameBRUSHY MOUNTAIN GROUP HOMES, INC
Location Address1224 SWAIN STNorth Wilkesboro, NC 28659-3343
Mailing AddressPo Box 1045North Wilkesboro, NC 28659-1045 · (336) 838-3789 · Fax (336) 838-3490
Phone(336) 838-7220
Fax(336) 838-3490
Organization SubpartNo
Authorized OfficialShelley Darlene GambleExecutive Director · (336) 838-3789
Enumeration DateAugust 15, 2006
Last NPPES UpdateJune 19, 2008
✔ NPI 1104939313 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities
Taxonomy Code320600000X
License✔ Licensed in NC · MHL097046
Definition
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.
1224 SWAIN ST, North Wilkesboro, NC 28659
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Other Names 1

Doing Business AsSwain Street Group Home

Other Identifiers 1

Medicaid7804483NC

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 34D2340648

Brushy Mountain Group Home, Inc · North Wilkesboro, NC
Active · expires Mar 19, 2028
CLIA Number34D2340648
Laboratory TypeIntermediate Care Facility For Mentally Retarded
Certificate Effective DateMarch 20, 2026
Certificate Expiration DateMarch 19, 2028
Laboratory DirectorJohnnie W. Everidge
Laboratory Phone(336) 984-9101
Laboratory LocationBrushy Mountain Group Home, Inc517 Boston Avenue, North Wilkesboro, NC 28659
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

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 Brushy Mountain Group Homes, Inc's NPI number?

The NPI number for Brushy Mountain Group Homes, Inc is 1104939313. It was assigned to this organization in the NPPES registry on August 15, 2006. The provider is doing business as Swain Street Group Home.

Where is Brushy Mountain Group Homes, Inc located?

Brushy Mountain Group Homes, Inc is located at 1224 Swain St, North Wilkesboro, NC 28659. The listed phone number is (336) 838-7220.

What is Brushy Mountain Group Homes, Inc's specialty?

The primary specialty registered for this NPI is Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320600000X.

Does Brushy Mountain Group Homes, Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2340648) is associated with this NPI, valid through March 19, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Brushy Mountain Group Homes, Inc was last updated on June 19, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.