NPIMap

Organization Active NPI

Cornelia Nixon Davis, Inc.

  • Skilled Nursing Facility
  • Wilmington, NC
National Provider Identifier
1356346191
Registry record updated Oct 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH0097 Issued in NC
Legal business name
CORNELIA NIXON DAVIS, INC.
Practice address
1011 Porters Neck Rd
Wilmington, NC 28411-9196
Phone
(910) 686-7195
Fax
(910) 686-7592
NPI assigned
Jun 17, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2018

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

Authorized official

Name
Mr. Charles Allen Long
Title
Executive Director
Phone
(910) 686-7195

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X
Skilled Nursing Facility 314000000X NH0097 NC Primary

Addresses

Primary practice location

1011 Porters Neck Rd
Wilmington, NC 28411-9196

Mailing address

1011 Porters Neck Rd
Wilmington, NC 28411-9196
Phone (910) 686-7195

Other identifiers 4

IdentifierTypeStateIssuer
3406154MedicaidNC
3405160MedicaidNC
7128883OtherNCUNITED HEALTHCARE
00820OtherNCBLUE CROSS

Other names 1

  • Davis Health Care Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040311000989 NC Part A Provider - Skilled Nursing Facility 3870482581 Practice locations: Wilmington, NC

Skilled nursing facility certification: CCN 345160

Legal name
CORNELIA NIXON DAVIS, INC.
Doing business as
DAVIS HEALTH CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Apr 1, 1976
Last certification
Feb 8, 2024
Beds
179 (115 certified)
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1966 in NC
Enrollment address
1011 Porters Neck Rd
Wilmington, NC 28411-9196
Nursing home name
DAVIS HEALTH CARE CENTER

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Davis Health Care CenterCCN 345160
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
3 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Apr 1, 1976
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
115108.0 residents per day on average
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
2Fines totaling $63,996

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Cornelia Nixon Davis Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mary Clements Individual Operational/Managerial Control Aug 16, 2024
Adp of the SNF Aug 16, 2024
Cornelia Nixon Davis, Inc. Organization, Wilmington, NC Corporation, Medical staffing company 5% Or Greater Direct Ownership Interest Jul 1, 1966 100%
Operational/Managerial Control Jul 1, 1966
Adp of the SNF Jul 1, 1966
Melissa J McAdams Welsh Individual Operational/Managerial Control Aug 13, 2024
Adp of the SNF Aug 13, 2024
Joanna Biehl Individual Operational/Managerial Control Dec 23, 2024
Adp of the SNF Dec 23, 2024
Audrey L Sutton-Surak Individual Adp of the SNF Jul 1, 2025
Charles Long Individual Corporate Director Mar 11, 2004
Operational/Managerial Control Jul 1, 2003
Adp of the SNF Jul 1, 2003

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Davis Health and Wellness at Cambridge VillageWilmington, NC, CCN 345568 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 6, 2015
May 6, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 9

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539907200000",
    "number": "1356346191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 PORTERS NECK RD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284119196",
            "telephone_number": "910-686-7195",
            "fax_number": "910-686-7592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 PORTERS NECK RD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284119196",
            "telephone_number": "910-686-7195",
            "fax_number": "910-686-7592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNELIA NIXON DAVIS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-17",
        "last_updated": "2018-10-19",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "910-686-7195",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0097",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406154",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3405160",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "7128883",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "00820",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Davis Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Davis Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.