Elliotte Manor #1

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

FCL060093 Issued in NC

Legal business name

ELLIOTTE MANOR #1

Practice address

10201 Connell Rd
Mint Hill, NC 28227-6947

Phone

(704) 545-1366

Fax

(704) 545-3561

NPI assigned

May 3, 2012

Last updated

May 3, 2012By 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

Mr. John Junious Elliotte

Title

Owner/Administrator

Phone

(704) 545-3051

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1336003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336003200000",
    "number": "1205194701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10201 CONNELL RD",
            "city": "MINT HILL",
            "state": "NC",
            "postal_code": "282276947",
            "telephone_number": "704-545-1366",
            "fax_number": "704-545-3561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10201 CONNELL RD",
            "city": "MINT HILL",
            "state": "NC",
            "postal_code": "282276947",
            "telephone_number": "704-545-1366",
            "fax_number": "704-545-3561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIOTTE MANOR #1",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-03",
        "last_updated": "2012-05-03",
        "status": "A",
        "authorized_official_last_name": "ELLIOTTE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "JUNIOUS",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "704-545-3051",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "FCL060093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Mint Hill, NC
• Providers in Mint Hill, NC by specialty
• Assisted Living Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2012; 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.