OrganizationActive
Pelham Supportive Services
NPI 1770924482 · Mental Illness Community Based Residential Treatment Facility · Fayetteville, NC
Provider details
- NPI number
- 1770924482
- Entity type
- Organization
- Primary specialty
- Mental Illness Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Mildred Wilson, Director(910) 488-7633
- License
- MHL-026-854 (NC)
Specialties & taxonomies
- Mental Illness Community Based Residential Treatment FacilityPrimary320800000XLicense MHL-026-854 (NC)
Residential Treatment Facilities
Profile Score
Detailed profile(77/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
12 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
5740 Longview Dr
Fayetteville, NC 28306-8567
Phone: (910) 425-4168
Fax: (910) 488-8823
Street-level locationGet directions
Mailing address
949 Country Club Dr
Fayetteville, NC 28301-2907
Other names (DBA / former)
- Doing business as
- Pelham Group Home #3
Registry dates
- Enumerated
- 2013-07-10
- Last updated
- 2013-07-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.