PELHAM GROUP HOME #1
NPI 1760544712
Community Based Residential Treatment Facility, Mental Illness in Fayetteville, NC

Q: What is Pelham Supportive Services's NPI number?

The NPI number for Pelham Supportive Services is 1760544712. It was assigned to this organization in the NPPES registry on December 15, 2006. The provider is doing business as Pelham Group Home #1.

Q: What is Pelham Supportive Services's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Mental Illness with taxonomy code 320800000X.

Active since December 15, 2006

1712 SHILOH DR, FAYETTEVILLE, NC 28304(910) 423-2800(910) 423-2800 Get Directions Write a Review

NPPES record last updated: July 10, 2013. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Pelham Group Home #1 NPPES

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

PELHAM GROUP HOME #1 (NPI 1760544712) is a healthcare organization registered as a community based residential treatment facility, mental illness in Fayetteville, North Carolina and active in the NPI registry since December 2006. The organization lists Mildred Wilson, Owner, as its authorized official.

NPPES Registry Identity

NPI1760544712

Entity TypeOrganization

Primary Taxonomy320800000X

Legal Business NamePELHAM SUPPORTIVE SERVICES

Location Address1712 SHILOH DRFayetteville, NC 28304-4027

Mailing Address949 Country Club DrFayetteville, NC 28301-2907 · (910) 630-6757 · Fax (910) 884-9806

Phone(910) 423-2800

Fax(910) 423-2800

Organization SubpartNo

Authorized OfficialMildred WilsonOwner · (910) 630-6757

Enumeration DateDecember 15, 2006

Last NPPES UpdateJuly 10, 2013

✔ NPI 1760544712 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Mental IllnessResidential Treatment Facilities

Taxonomy Code320800000X

License✔ Licensed in NC · MHL-026-823

Definition

A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

1712 SHILOH DR, Fayetteville, NC 28304

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Other Names 1

Doing Business AsPelham Group Home #1

Other Identifiers 1

Medicaid7806025NC

Other Providers at the Same Location NPPES

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

FAMILY FIRST GROUP HOME

Community Based Residential Treatment Facility, Mental Illness

1712 SHILOH DR
FAYETTEVILLE, NC 28304

Cumberland County (910) 495-6137

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 Pelham Supportive Services's NPI number?

The NPI number for Pelham Supportive Services is 1760544712. It was assigned to this organization in the NPPES registry on December 15, 2006. The provider is doing business as Pelham Group Home #1.

Where is Pelham Supportive Services located?

Pelham Supportive Services is located at 1712 Shiloh Dr, Fayetteville, NC 28304. The listed phone number is (910) 423-2800.

What is Pelham Supportive Services's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Mental Illness with taxonomy code 320800000X.

When was this NPI record last updated?

The NPPES record for Pelham Supportive Services was last updated on July 10, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.