Provider Demographics
| NPI: | 1356542203 |
|---|---|
| Name: | THOMAS-NABINETT-THOMAS GROUP |
| Entity type: | Organization |
| Organization Name: | THOMAS-NABINETT-THOMAS GROUP |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CHIEF FINANCIAL OFFICER |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | JAMES |
| Authorized Official - Middle Name: | B |
| Authorized Official - Last Name: | THOMAS |
| Authorized Official - Suffix: | III |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 704-652-0628 |
| Mailing Address - Street 1: | 205 EDGEWATER DR |
| Mailing Address - Street 2: | |
| Mailing Address - City: | CONCORD |
| Mailing Address - State: | NC |
| Mailing Address - Zip Code: | 28027-5572 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 704-652-0628 |
| Mailing Address - Fax: | 704-652-0628 |
| Practice Address - Street 1: | 505 MASK RD |
| Practice Address - Street 2: | |
| Practice Address - City: | MOUNT GILEAD |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 27306-9170 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 704-701-0891 |
| Practice Address - Fax: | 704-652-0628 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-05-29 |
| Last Update Date: | 2007-07-25 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| NC | MHL-062-022 NC | 320600000X, 320900000X, 385H00000X, 385HR2060X, 320800000X, 251S00000X, 320700000X, 385HR2065X, 385HR2055X, 323P00000X |
| NC | MHL-062-022 | 347C00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | |
| No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 347C00000X | Transportation Services | Private Vehicle | |
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 385H00000X | Respite Care Facility | Respite Care | |
| No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
| No | 251S00000X | Agencies | Community/Behavioral Health | |
| No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | |
| No | 385HR2065X | Respite Care Facility | Respite Care | Respite Care, Physical Disabilities, Child |
| No | 385HR2055X | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child |
