A Good Life Family Care Home

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

FCL-092-106 Issued in NC

Legal business name

A GOOD LIFE FAMILY CARE HOME

Practice address

4013 Tryon Rd
Raleigh, NC 27606-4209

Phone

(919) 834-3966

Fax

(919) 834-3966

NPI assigned

Apr 22, 2009

Last updated

Apr 22, 2009By 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

Mrs. Diane Cole Ballentine

Title

Owner/Administrator

Phone

(919) 834-3966

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1240358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240358400000",
    "number": "1124262050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4013 TRYON RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276064209",
            "telephone_number": "919-834-3966",
            "fax_number": "919-834-3966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4013 TRYON RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276064209",
            "telephone_number": "919-834-3966",
            "fax_number": "919-834-3966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A GOOD LIFE FAMILY CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-22",
        "last_updated": "2009-04-22",
        "status": "A",
        "authorized_official_last_name": "BALLENTINE",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "COLE",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "919-834-3966",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "FCL-092-106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2009; 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.