J. L. REDFORD, INC. (J. L. REDFORD, INC.) NPI 1932215886

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

Organization Community Based Residential Treatment Fa...

About J. L. REDFORD, INC. (J. L. REDFORD, INC.)

J. L. Redford, Inc. (j. L. Redford, Inc.) 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 J. L. Redford, Inc. (j. L. Redford, Inc.) is 1932215886 and was assigned on August 2006. The practitioner's primary taxonomy code is 320900000X. The provider is registered as an organization and their NPI record was last updated 5 years ago. The provider's former legal business name is J. L. Redford, Inc.. The authorized official of this NPI record is Mrs. Gloria R. Faulkner Master's Degree (Owner/administrator)

NPI

1932215886

Provider NameJ. L. REDFORD, INC. (J. L. REDFORD, INC.)
Provider Location Address1922 MARTIN LUTHER KING, JR. DRIVE WINSTON SALEM, NC 27107
Provider Mailing Address1922 MARTIN LUTHER KING, JR. DRIVE WINSTON SALEM, NC 27107
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameJ. L. REDFORD, INC.
Other Name TypeFormer Legal Business Name (4)
Enumeration Date08-22-2006
Last Update Date10-06-2015

Primary Taxonomy

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

Business Address

J. L. REDFORD, INC.
1922 MARTIN LUTHER KING, JR. DRIVE
WINSTON SALEM, NC
ZIP 27107
Phone: (336) 972-0053
Fax: (336) 720-9521

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Mailing Address

J. L. REDFORD, INC.
1922 MARTIN LUTHER KING, JR. DRIVE
WINSTON SALEM, NC
ZIP 27107
Phone: (336) 972-0531
Fax: (336) 720-9521

Authorized Official

Authorized Official NameMRS. GLORIA R. FAULKNER MASTER'S DEGREE
Authorized Official TitleOWNER/ADMINISTRATOR
Authorized Official Phone(336) 972-0531

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities4537NCNo

Taxonomy Description: a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.

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
3409110MEDICAID (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.