Derek'S Place 2

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

DEREK'S PLACE 2

Practice address

8025 N Point Blvd Ste 265
Winston Salem, NC 27106-3859

Phone

(336) 575-4463

NPI assigned

Dec 3, 2021

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, M.A

Title

Administrator

Phone

(336) 726-4309

Specialties & licenses 6

Addresses

Locations

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

{
    "created_epoch": "1638489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645574400000",
    "number": "1043978331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 NE 21ST ST",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271056208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8025 N POINT BLVD STE 265",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271063859",
            "telephone_number": "336-575-4463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEREK'S PLACE 2",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-03",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A",
        "authorized_official_last_name": "HAIRSTON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "336-726-4309",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.A"
    },
    "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": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• 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 Feb 23, 2022; 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.