NPIMap

Organization Active NPI

De Good Shephard Senior Living

  • Assisted Living Facility
  • Mint Hill, NC
National Provider Identifier
1093459372
Registry record updated Apr 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
DE GOOD SHEPHARD SENIOR LIVING
Practice address
14809 Bridgewater LN
Mint Hill, NC 28227-8514
Phone
(980) 299-0010
Fax
(980) 299-3006
NPI assigned
Apr 23, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2022

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

Authorized official

Name
Dorothy Ijeoma Ezekwe-Anya, DO
Title
Administrator
Phone
(170) 439-0646

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

14809 Bridgewater LN
Mint Hill, NC 28227-8514

Mailing address

14809 Bridgewater LN
Mint Hill, NC 28227-8514
Phone (980) 299-0010

Other names 1

  • De Good Shephard Senior Living Inc. Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1650672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650672000000",
    "number": "1093459372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14809 BRIDGEWATER LN",
            "city": "MINT HILL",
            "state": "NC",
            "postal_code": "282278514",
            "telephone_number": "980-299-0010",
            "fax_number": "980-299-3006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14809 BRIDGEWATER LN",
            "city": "MINT HILL",
            "state": "NC",
            "postal_code": "282278514",
            "telephone_number": "980-299-0010",
            "fax_number": "980-299-3006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DE GOOD SHEPHARD SENIOR LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-23",
        "last_updated": "2022-04-23",
        "certification_date": "2022-04-22",
        "status": "A",
        "authorized_official_last_name": "EZEKWE-ANYA",
        "authorized_official_first_name": "DOROTHY",
        "authorized_official_middle_name": "IJEOMA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "170-439-0646",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "De Good Shephard Senior Living Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mint Hill, NC

Sources for this page

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