CHURCH STREET GROUP HOME LLC
NPI 1821389776
Assisted Living Facility - Assisted Living, Mental Illness in Burlington, NC

Q: What is Church Street Group Home LLC's NPI number?

The NPI number for Church Street Group Home LLC is 1821389776. It was assigned to this organization in the NPPES registry on April 27, 2011.

Q: What is Church Street Group Home LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility, specializing in Assisted Living, Mental Illness, with taxonomy code 3104A0625X.

Active since April 27, 2011

1017 S CHURCH ST, BURLINGTON, NC 27215(336) 227-1613(336) 227-1613 Get Directions Write a Review

NPPES record last updated: April 27, 2011. Verified against the NPPES registry weekly; last sync: August 30, 2026.

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About Church Street Group Home Llc NPPES

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

CHURCH STREET GROUP HOME LLC (NPI 1821389776) is a healthcare organization registered as an assisted living, mental illness in Burlington, North Carolina and active in the NPI registry since April 2011. The organization lists Mittie B Fuller, President/owner, as its authorized official.

NPPES Registry Identity

NPI1821389776

Entity TypeOrganization

Primary Taxonomy3104A0625X

Legal Business NameCHURCH STREET GROUP HOME LLC

Location Address1017 S CHURCH STBurlington, NC 27215-5045

Mailing AddressPo Box 1996Burlington, NC 27216-1996 · (336) 227-1613 · Fax (336) 227-1613

Phone(336) 227-1613

Fax(336) 227-1613

Organization SubpartNo

Authorized OfficialMittie B FullerPresident/owner · (336) 227-1613

Enumeration DateApril 27, 2011

✔ NPI 1821389776 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living Facility · Assisted Living, Mental IllnessNursing & Custodial Care Facilities

Taxonomy Code3104A0625X

License✔ Licensed in NC · MHL-001-213

Definition

A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies.

1017 S CHURCH ST, Burlington, NC 27215

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Other Providers at the Same Location NPPES

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

MURPHY'S GROUP HOME LLC

Assisted Living Facility (Assisted Living, Mental Illness)

1017 S CHURCH ST
BURLINGTON, NC 27215

Alamance County (336) 570-0243

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 Church Street Group Home LLC's NPI number?

The NPI number for Church Street Group Home LLC is 1821389776. It was assigned to this organization in the NPPES registry on April 27, 2011.

Where is Church Street Group Home LLC located?

Church Street Group Home LLC is located at 1017 S Church St, Burlington, NC 27215. The listed phone number is (336) 227-1613.

What is Church Street Group Home LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility, specializing in Assisted Living, Mental Illness, with taxonomy code 3104A0625X.

When was this NPI record last updated?

The NPPES record for Church Street Group Home LLC was last updated on April 27, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.