Provider Demographics
NPI:1164578886
Name:COLUMBUS GROUP HOMES, INC.
Entity Type:Organization
Organization Name:COLUMBUS GROUP HOMES, INC.
Other - Org Name:COLUMBUS HOUSE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-640-1557
Mailing Address - Street 1:805 N FRANKLIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-2735
Mailing Address - Country:US
Mailing Address - Phone:910-640-1557
Mailing Address - Fax:910-640-0814
Practice Address - Street 1:805 N FRANKLIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-2735
Practice Address - Country:US
Practice Address - Phone:910-640-1557
Practice Address - Fax:910-640-0814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL024017320800000X
NCMHL024014320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408591Medicaid
NC8301088BMedicaid
NC7802395Medicaid
NC7802400Medicaid
NC7802403Medicaid
NC8301088Medicaid