Organization
MARTHA'S GROUP HOMES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS TREVOUR SHEPARD QMHP, BS (MANAGER)
(910) 938-0670
Entity
Organization
Contact information
Practice address
516 E SPRINGHILL TER, JACKSONVILLE, NC 28546-7366
(910) 938-0670
(910) 938-1229
Mailing address
516 E SPRINGHILL TER, JACKSONVILLE, NC 28546-7366
(910) 938-0670
(910) 938-1229
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
MHL067-069
NC
251S00000X
Community/Behavioral Health Agency
MHL067-069
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301498
—
NC
Enumeration date
03/01/2007
Last updated
09/11/2025
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