CLIMBING JACOBS LADDER LLC NPI 1215024682

Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities in Winston Salem, NC

Organization Community Based Residential Treatment Fa...

About CLIMBING JACOBS LADDER LLC

Climbing Jacobs Ladder Llc is a provider established in Winston Salem, North Carolina specializing in community based residential treatment facility, mental retardation and/or developmental disabilities. The NPI number of Climbing Jacobs Ladder Llc is 1215024682 and was assigned on October 2006. The practitioner's primary taxonomy code is 320900000X. The provider is registered as an organization and their NPI record was last updated 12 years ago. The authorized official of this NPI record is Mr. James Robert Paul (Director)

NPI

1215024682

Provider NameCLIMBING JACOBS LADDER LLC
Provider Location Address3401 HEALY DR SUITE-B WINSTON SALEM, NC 27103
Provider Mailing Address7475 PRINCESS ANNE CT SUITE -B RURAL, NC 27045
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date10-06-2006
Last Update Date06-10-2008

Primary Taxonomy

Taxonomy Code320900000X
ClassificationCommunity Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities
TypeResidential Treatment Facilities
Taxonomy DescriptionA home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.

Business Address

CLIMBING JACOBS LADDER LLC
3401 HEALY DR
SUITE-B
WINSTON SALEM, NC
ZIP 27103
Phone: (336) 760-5516
Fax: (336) 760-5517

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Mailing Address

CLIMBING JACOBS LADDER LLC
7475 PRINCESS ANNE CT
SUITE -B
RURAL, NC
ZIP 27045
Phone: (336) 760-5516
Fax: (336) 760-5517

Authorized Official

Authorized Official NameMR. JAMES ROBERT PAUL
Authorized Official TitleDIRECTOR
Authorized Official Phone(336) 760-5516

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
8301092MEDICAID (05)NC

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The 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 Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type 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 (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization 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 Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.