Provider Demographics
NPI:1760568778
Name:WHITFIELD HOMES INC.
Entity Type:Organization
Organization Name:WHITFIELD HOMES INC.
Other - Org Name:WHITFIELD HOMES ASP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PERCY
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:910-592-5462
Mailing Address - Street 1:202 SAMPSON ST
Mailing Address - Street 2:1
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2864
Mailing Address - Country:US
Mailing Address - Phone:910-592-5462
Mailing Address - Fax:910-590-2754
Practice Address - Street 1:202 SAMPSON ST
Practice Address - Street 2:1
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2864
Practice Address - Country:US
Practice Address - Phone:910-592-5462
Practice Address - Fax:910-590-2754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-082-040320600000X
NCMHL-082-054320600000X
NCMHL-026-736320600000X
NCMHL-082-045320600000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301367BMedicaid
NC3409425OtherCAP PROVIDER