NPIMap

Organization Active NPI

Leslie Evelyn Todd Oak Grove Family Care

  • Assisted Living Facility
  • Bladenboro, NC
National Provider Identifier
1073796264
Registry record updated Jun 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
FCL-009-008 Issued in NC
Legal business name
LESLIE EVELYN TODD OAK GROVE FAMILY CARE
Practice address
583 Sassafras Rd
Route 4 Box 271
Bladenboro, NC 28320-5925
Phone
(910) 648-2176
Fax
(910) 648-5785
NPI assigned
Dec 11, 2007
Last updated
Jun 18, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2008

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

Authorized official

Name
Andrea Callihan Dove, ADMINISTRATOR, LPN
Title
Administrator
Phone
(910) 648-2176

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X FCL-009-008 NC Primary

Addresses

Primary practice location

583 Sassafras Rd
Route 4 Box 271
Bladenboro, NC 28320-5925

Mailing address

583 Sassafras Rd
Bladenboro, NC 28320-5925
Phone (910) 648-2176

Other identifiers 1

IdentifierTypeStateIssuer
7802347MedicaidNC

Other names 1

  • oak grove family care Other name

National Provider Directory

National Provider Directory
Tax ID family
Leslie Evelyn Todd Oak Grove Family Care2 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.

Locations

583 Sassafras Rd
#4
Bladenboro, NC 28320
Phone (910) 648-2176

NPI Registry JSON

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

{
    "created_epoch": "1197331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1073796264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "583 SASSAFRAS RD",
            "city": "BLADENBORO",
            "state": "NC",
            "postal_code": "283205925",
            "telephone_number": "910-648-2176",
            "fax_number": "910-648-5785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "583 SASSAFRAS RD",
            "address_2": "ROUTE 4 BOX 271",
            "city": "BLADENBORO",
            "state": "NC",
            "postal_code": "283205925",
            "telephone_number": "910-648-2176",
            "fax_number": "910-648-5785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LESLIE EVELYN TODD OAK GROVE FAMILY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-11",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "DOVE",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "CALLIHAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "910-648-2176",
        "authorized_official_credential": "ADMINISTRATOR, LPN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "FCL-009-008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7802347",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "oak grove family care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bladenboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 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.