Mercys Supportive Living

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

FCL064-027 Issued in NC

Legal business name

MERCYS SUPPORTIVE LIVING

Practice address

932 Cobble Ridge Rd
Nashville, NC 27856-7868

Phone

(252) 443-6811

Fax

(252) 443-6811

NPI assigned

Jan 23, 2015

Organization subpart

No

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

Authorized official

Name

Isaac Conrad Brake

Title

Administrator

Phone

(252) 443-6811

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1421971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425427200000",
    "number": "1124418595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "932 COBBLE RIDGE RD",
            "city": "NASHVILLE",
            "state": "NC",
            "postal_code": "278567868",
            "telephone_number": "252-443-6811",
            "fax_number": "252-443-6811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "932 COBBLE RIDGE RD",
            "city": "NASHVILLE",
            "state": "NC",
            "postal_code": "278567868",
            "telephone_number": "252-443-6811",
            "fax_number": "252-443-6811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCYS SUPPORTIVE LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-23",
        "last_updated": "2015-03-04",
        "status": "A",
        "authorized_official_last_name": "BRAKE",
        "authorized_official_first_name": "ISAAC",
        "authorized_official_middle_name": "CONRAD",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "252-443-6811"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "FCL064-027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Nashville, NC
• Providers in Nashville, 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 Mar 4, 2015; 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.