Priddy Manor Assisted Living

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

HAL085009 Issued in NC

Legal business name

PRIDDY MANOR ASSISTED LIVING

Practice address

1294 Priddy Road
King, NC 27021

Phone

(336) 983-3068

Fax

(336) 995-6098

NPI assigned

Aug 22, 2013

Last updated

Aug 22, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Steve Bailey

Title

VP

Phone

(336) 993-7555

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1377129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377129600000",
    "number": "1053745471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "853 OLD WINSTON RD",
            "address_2": "SUITE 118",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847143",
            "telephone_number": "336-993-7555",
            "fax_number": "336-993-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1294 PRIDDY ROAD",
            "city": "KING",
            "state": "NC",
            "postal_code": "27021",
            "telephone_number": "336-983-3068",
            "fax_number": "336-995-6098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIDDY MANOR ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-22",
        "last_updated": "2013-08-22",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "336-993-7555",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "HAL085009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morgan Ruth Poindexter
• Alexa Moorefield Pope, MD
• Pqa Healthcare, Inc
• Pqa Healthcare, Inc
• Brittney Heath Preslar, FNP-C
• Priddy Manor LLC
• Heather Pullium, NP
• Sean Peter Reynolds, PA-C
• Rha Health Services Inc
• Rha Health Services Inc

• Adult Care Home Facility in King, NC
• Providers in King, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2013; 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.