Active NPI
Independent Living Group Home, LLC
- Community/Behavioral Health Agency
- Winston Salem, NC
National Provider Identifier
1093991234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- Legal business name
- INDEPENDENT LIVING GROUP HOME, LLC
- Practice address
- 924 Cloister Dr
Winston Salem, NC 27127 - Phone
- (336) 767-4540
- Fax
- (336) 283-9288
- NPI assigned
- Jan 17, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Shanita Lovelace, RN
- Title
- Director/ Owner
- Phone
- (336) 767-4540
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Primary | ||
| Adult Care Home Facility | 311ZA0620X | |||
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | 034-224 | NC | |
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X |
Addresses
Primary practice location
924 Cloister Dr
Winston Salem, NC 27127
Mailing address
7748 N Point Blvd
Winston Salem, NC 27106-3310
Phone (336) 767-4540
Other practice location 1
1316 Calvert Dr
Winston Salem, NC 27107-1302
Phone (336) 842-3384
Other practice location 2
1712 Thompson Dr
Winston Salem, NC 27127-5814
Phone (336) 788-5781
Other practice location 3
2415 Old Salisbury Rd
Winston Salem, NC 27127-5823
Phone (336) 788-2319
Other practice location 4
355 Ransom Rd
Winston Salem, NC 27106-3835
Phone (336) 893-5495
Other practice location 5
7748 N Point Blvd
Winston Salem, NC 27106-3310
Phone (336) 767-4540 ext. 208
National Provider Directory
National Provider DirectoryLocations
355 Ransom Rd
Winston Salem, NC 27106
Phone (336) 768-3107
7748 N Point Blvd
Winston Salem, NC 27106
Phone (336) 767-4353
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200528000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1574035200000",
"number": "1093991234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7748 N POINT BLVD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271063310",
"telephone_number": "336-767-4540",
"fax_number": "336-499-0651"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "924 CLOISTER DR",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "27127",
"telephone_number": "336-767-4540",
"fax_number": "336-283-9288"
}
],
"practiceLocations": [
{
"address_1": "1316 Calvert Dr",
"address_purpose": "LOCATION",
"city": "Winston Salem",
"state": "NC",
"postal_code": "271071302",
"country_code": "US",
"telephone_number": "336-842-3384",
"fax_number": "336-283-9288",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1712 Thompson Dr",
"address_purpose": "LOCATION",
"city": "Winston Salem",
"state": "NC",
"postal_code": "271275814",
"country_code": "US",
"telephone_number": "336-788-5781",
"fax_number": "336-283-9288",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2415 Old Salisbury Rd",
"address_purpose": "LOCATION",
"city": "Winston Salem",
"state": "NC",
"postal_code": "271275823",
"country_code": "US",
"telephone_number": "336-788-2319",
"fax_number": "336-283-9288",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "355 Ransom Rd",
"address_purpose": "LOCATION",
"city": "Winston Salem",
"state": "NC",
"postal_code": "271063835",
"country_code": "US",
"telephone_number": "336-893-5495",
"fax_number": "336-283-9288",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "7748 N Point Blvd",
"address_purpose": "LOCATION",
"city": "Winston Salem",
"state": "NC",
"postal_code": "271063310",
"country_code": "US",
"telephone_number": "336-767-4540 x208",
"fax_number": "336-283-9288",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "INDEPENDENT LIVING GROUP HOME, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-01-17",
"last_updated": "2019-11-18",
"status": "A",
"authorized_official_last_name": "LOVELACE",
"authorized_official_first_name": "SHANITA",
"authorized_official_title_or_position": "DIRECTOR/ OWNER",
"authorized_official_telephone_number": "336-767-4540",
"authorized_official_credential": "RN"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": true
},
{
"code": "311ZA0620X",
"taxonomy_group": "",
"desc": "Custodial Care Facility, Adult Care Home",
"state": null,
"license": null,
"primary": false
},
{
"code": "320600000X",
"taxonomy_group": "",
"desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": "NC",
"license": "034-224",
"primary": false
},
{
"code": "320900000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.