Davenport Family Services LLC

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

DAVENPORT FAMILY SERVICES LLC

Practice address

3412 Thistle Bloom CT
Charlotte, NC 28269-1309

Phone

(980) 384-8103

NPI assigned

Oct 19, 2023

Organization subpart

No

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

Authorized official

Name

Jermaine Davenport

Title

Ceo

Phone

(828) 279-4443

Specialties & licenses 5

Addresses

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

{
    "created_epoch": "1697673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697673600000",
    "number": "1225810609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3412 THISTLE BLOOM CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282691309",
            "telephone_number": "980-384-8103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3412 THISTLE BLOOM CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282691309",
            "telephone_number": "980-384-8103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVENPORT FAMILY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-19",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "JERMAINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "828-279-4443"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ajal M Dave, MD
• Anjalee Kishor Dave, MD
• Christine Sita Dave, LPC
• Pujan Bhavin Dave, MD
• Amanda Marie Davee Lomax
• Angela A. Davenport, MA, CCC-SLP
• Carson Scott Davenport, D.D.S.
• Lauren Davenport, NP
• Russell Emmett Davenport III, M.D.
• Sasha Zeenat Davenport, MD

• Intellectual Disabilities Intermediate Care Facility in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Intellectual Disabilities Intermediate Care Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2023; 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.