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FAYETTEVILLE STREET COMMUNITY LIVING HOME
NPI 1295998029
Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Durham, NC

Active since July 02, 2008CLIA 34D2105003 · Waiver
111 N MAPLE ST, DURHAM, NC 27703(919) 519-0016(919) 596-0645 Get Directions Write a Review

NPPES record last updated: December 12, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Fayetteville Street Community Living Home NPPES

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

FAYETTEVILLE STREET COMMUNITY LIVING HOME (NPI 1295998029) is a healthcare organization registered as a residential treatment facility, intellectual and/or developmental disabilities in Durham, North Carolina and active in the NPI registry since July 2008. The organization holds a CLIA Waiver certificate valid through May 14, 2027 and lists Robin Artis Williams, Administor, as its authorized official.

NPPES Registry Identity

NPI1295998029
Entity TypeOrganization
Primary Taxonomy320600000X
Legal Business NameFAYETTEVILLE STREET COMMUNITY LIVING HOME
Location Address111 N MAPLE STDurham, NC 27703-3021
Mailing Address111 N Maple StDurham, NC 27703-3021 · (919) 519-0016 · Fax (919) 596-0645
Phone(919) 519-0016
Fax(919) 596-0645
Organization SubpartNo
Authorized OfficialRobin Artis WilliamsAdministor · (919) 519-0016
Enumeration DateJuly 2, 2008
Last NPPES UpdateDecember 12, 2013
✔ NPI 1295998029 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 · MHL032445
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.
111 N MAPLE ST, Durham, NC 27703
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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 34D2105003

Fayetteville Street Community Living Home LLC · Durham, NC
Active · expires May 14, 2027
CLIA Number34D2105003
Laboratory TypeAssisted Living Facility
Certificate Effective DateMay 15, 2025
Certificate Expiration DateMay 14, 2027
Laboratory DirectorRobin Williams
Laboratory Phone(919) 401-8564
Laboratory LocationFayetteville Street Community Living Home LLC111 North Maple Street, Durham, NC 27703
CLIA data matches this NPI record on: Address 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 Fayetteville Street Community Living Home's NPI number?

The NPI number for Fayetteville Street Community Living Home is 1295998029. It was assigned to this organization in the NPPES registry on July 2, 2008.

Where is Fayetteville Street Community Living Home located?

Fayetteville Street Community Living Home is located at 111 N Maple St, Durham, NC 27703. The listed phone number is (919) 519-0016.

What is Fayetteville Street Community Living Home's specialty?

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

Does Fayetteville Street Community Living Home hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2105003) is associated with this NPI, valid through May 14, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Fayetteville Street Community Living Home was last updated on December 12, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.