Canaan Care Home, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

MHL-092-546 Issued in NC

Legal business name

CANAAN CARE HOME, LLC

Practice address

429/431 Waldo St
Cary, NC 27511-3539

Phone

(919) 467-4574

NPI assigned

Jan 25, 2007

Last updated

Mar 1, 2013By 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

Daniel K Gatabaki

Title

Administrator

Phone

(919) 467-4574

Specialties & licenses 1

Addresses

Other identifiers 3

Tax ID family

Canaan Care Home LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Canaan Care Home, LLC

  • Assisted Living Facility
  • Wake Forest, NC
  • NPI 1356475784
  NPD tax ID

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362096000000",
    "number": "1285780106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "429/431 WALDO ST",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275113539",
            "telephone_number": "919-467-4574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429/431 WALDO ST",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275113539",
            "telephone_number": "919-467-4574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANAAN CARE HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2013-03-01",
        "status": "A",
        "authorized_official_last_name": "GATABAKI",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "919-467-4574"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "MHL-092-546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805331",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3418344",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805760",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nalazjah Asiyana Nichole Campbell
• Steven W Campbell, DMD
• Ta-Taya Campbell
• Amber Katlyn Campos
• Jennifer Jasmine Campos, LCAS-A, LCSW-A
• Britny Canady
• Hameka Canady, BSN
• Breanna M Canales
• Cancer Centers of North Carolina PC
• Cancer Centers of North Carolina, PC

• Assisted Living Facility in Cary, NC
• Providers in Cary, 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 Mar 1, 2013; 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.