NPIMap

Organization Active NPI

Skill Creations

  • Intellectual Disabilities Intermediate Care Facility
  • Goldsboro, NC
National Provider Identifier
1194077024
Registry record updated Jan 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
MHL-096-007 Issued in NC
Legal business name
SKILL CREATIONS
Practice address
2101 Royall Ave
Goldsboro, NC 27534-7408
Phone
(919) 736-7471
NPI assigned
Oct 2, 2012
Last updated
Jan 18, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
SKILL CREATIONS INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 18, 2019

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

Authorized official

Name
Paul Hackmann
Title
Ceo
Phone
(919) 734-7398

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X MHL-096-007 NC
Intellectual Disabilities Intermediate Care Facility 315P00000X MHL-096-007 NC Primary

Addresses

Primary practice location

2101 Royall Ave
Goldsboro, NC 27534-7408

Mailing address

PO Box 1636
Goldsboro, NC 27533-1636
Phone (919) 734-7398

Other identifiers 1

IdentifierTypeStateIssuer
3406339MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194077024. Details of each certification follow.

  • CCN 34G040 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 34G040

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SKILL CREATIONS
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jun 4, 1986
Last certification
Jan 13, 2026
Beds
15
Ownership / control type
Private (non-profit)
Most recent change of ownership
Aug 31, 2018
Facility address
2101 Royall Ave
Goldsboro, NC 27534

National Provider Directory

National Provider Directory
Tax ID family
Skill Creations of Sanford24 organizations share this tax ID, including this one
Part of
Skill Creations of Sanford

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

Locations

2101 Royall Ave
Goldsboro, NC 27534
Phone (919) 736-7471

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1349136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547769600000",
    "number": "1194077024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1636",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275331636",
            "telephone_number": "919-734-7398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 ROYALL AVE",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275347408",
            "telephone_number": "919-736-7471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKILL CREATIONS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SKILL CREATIONS INCORPORATED",
        "enumeration_date": "2012-10-02",
        "last_updated": "2019-01-18",
        "status": "A",
        "authorized_official_last_name": "HACKMANN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-734-7398"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NC",
            "license": "MHL-096-007",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": "MHL-096-007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406339",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goldsboro, NC

Sources for this page

Verify at the official NPI Registry.