Derek'S Place

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

DEREK'S PLACE

Practice address

150 Secret Garden LN
Apt 1
Winston Salem, NC 27104-4721

Phone

(336) 671-3046

NPI assigned

Nov 8, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Eric Hairston

Title

Executive Administrator

Phone

(336) 671-3046

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1478563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478563200000",
    "number": "1033651070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 SECRET GARDEN LN",
            "address_2": "APT 1",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271044721",
            "telephone_number": "336-671-3046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 SECRET GARDEN LN",
            "address_2": "APT 1",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271044721",
            "telephone_number": "336-671-3046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEREK'S PLACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-08",
        "last_updated": "2016-11-08",
        "status": "A",
        "authorized_official_last_name": "HAIRSTON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "EXECUTIVE ADMINISTRATOR",
        "authorized_official_telephone_number": "336-671-3046",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martha Jo Denton, NP
• Staci R Denton
• Joel Krishna Deonanan, M.D.
• Department of Veterans Affairs
• Dept of Veterans Affairs Outpatient Clinic
• Derek'S Place 2
• Alexander Dergins
• Christine Derisse
• Natalie Simone Deroche
• Jessica Cipoletti Derreberry, M.D.

• Home Health Agency in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Home Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 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.