Provider Demographics
NPI:1124157730
Name:MARY TAYLOR HOMES
Entity type:Organization
Organization Name:MARY TAYLOR HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:252-566-8455
Mailing Address - Street 1:6957 NC HIGHWAY 903 S
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:NC
Mailing Address - Zip Code:28551-8367
Mailing Address - Country:US
Mailing Address - Phone:252-566-8455
Mailing Address - Fax:252-566-8455
Practice Address - Street 1:6957 NC HIGHWAY 903 S
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:NC
Practice Address - Zip Code:28551-8367
Practice Address - Country:US
Practice Address - Phone:252-566-8455
Practice Address - Fax:252-566-8455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2007-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-040-036251B00000X, 251C00000X, 261QA0005X, 3104A0625X, 311Z00000X, 315P00000X, 320600000X, 320700000X, 332900000X, 3336L0003X, 343900000X, 347C00000X, 385H00000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No332900000XSuppliersNon-Pharmacy Dispensing Site
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care