The Village on Campbell LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH0461 Issued in NC

Legal business name

THE VILLAGE ON CAMPBELL LLC

Practice address

311 S Campbell St
Burgaw, NC 28425-5011

Phone

(910) 259-6007

Fax

(910) 259-6111

NPI assigned

Oct 14, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Hugh Blaine Campbell III

Title

Manager

Phone

(910) 332-4508

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476403200000",
    "number": "1003367053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 S CAMPBELL ST",
            "city": "BURGAW",
            "state": "NC",
            "postal_code": "284255011",
            "telephone_number": "910-259-6007",
            "fax_number": "910-259-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 S CAMPBELL ST",
            "city": "BURGAW",
            "state": "NC",
            "postal_code": "284255011",
            "telephone_number": "910-259-6007",
            "fax_number": "910-259-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE VILLAGE ON CAMPBELL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-14",
        "last_updated": "2016-10-14",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "HUGH",
        "authorized_official_middle_name": "BLAINE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "910-332-4508",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC LICENSE",
            "identifier": "NH0461",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.