Jeanne Culp Moore

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

FCL-084-002 Issued in NC

Legal business name

JEANNE CULP MOORE

Doing business as

Forever Young Retreat

Practice address

44913 Byrd Rd
Albemarle, NC 28001-7876

Phone

(704) 422-6530

Fax

(704) 422-5221

NPI assigned

Jan 18, 2007

Organization subpart

No

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

Authorized official

Name

Jeanne Culp Moore

Title

Owner-Administrator

Phone

(704) 422-6530

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Forever Young Retreat Doing business as

Tax ID family

Forever Young Retreat2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Jeanne Culp Moore

  • Assisted Living Facility
  • Albemarle, NC
  • NPI 1982756862
  NPD tax ID

Locations

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1013069855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44913 BYRD RD",
            "city": "ALBEMARLE",
            "state": "NC",
            "postal_code": "280017876",
            "fax_number": "704-422-5221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44913 BYRD RD",
            "city": "ALBEMARLE",
            "state": "NC",
            "postal_code": "280017876",
            "telephone_number": "704-422-6530",
            "fax_number": "704-422-5221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEANNE CULP MOORE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JEANNE",
        "authorized_official_middle_name": "CULP",
        "authorized_official_title_or_position": "OWNER-ADMINISTRATOR",
        "authorized_official_telephone_number": "704-422-6530"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "FCL-084-002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7803511",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Forever Young Retreat",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• J. Lemmons, DDS and Associates, PA
• James W. Rokos DDS Ms PLLC
• Janice L. Whitley
• Cynthia Henry Jarman, C.PED, CFO
• Jaxi Transportation, LLC
• Jeanne Culp Moore
• John W Eckman III
• James William John, M.D.
• Eric Merriman Johnsen, M.D.
• Alison L. Johnson, OTD, OTR/L

• Assisted Living Facility in Albemarle, NC
• Providers in Albemarle, NC by specialty
• Assisted Living Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.