MEDICARE: LILLIE MAE JAMES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1760349385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIE MAE JAMES

Provider Business Mailing Address
First Line	:	809 AMARILLO ROSE LN
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27712-1481
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	809 AMARILLO ROSE LN
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27712-1481
Country	:	US
Telephone Number	:	919-525-9504
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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