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NPI 1164641601 · Mental Illness Intermediate Care Facility · Fayetteville, NC
Provider details
- NPI number
- 1164641601
- Entity type
- Organization
- Primary specialty
- Mental Illness Intermediate Care FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Donna Black, Chief Executive Officer(910) 574-7239
- License
- MHL-026-835 (NC)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
3319 Auburn Dr
Fayetteville, NC 28306-9353
Phone: (910) 425-5725
Street-level locationGet directions
Mailing address
2433 Gray Goose Loop
Fayetteville, NC 28306-7796
Registry dates
- Enumerated
- 2007-04-24
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.