Preston House I, LLC

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

License

HAL060031 Issued in NC

Legal business name

PRESTON HOUSE I, LLC

Practice address

4910 Harris Woods Blvd
Charlotte, NC 28269-0486

Phone

(704) 921-9279

Fax

(704) 896-1978

NPI assigned

Jan 19, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Norman J. Gordon

Title

Administrator

Phone

(704) 895-3645

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366595647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 837",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "280360837",
            "telephone_number": "704-895-3645",
            "fax_number": "704-896-1978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4910 HARRIS WOODS BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282690486",
            "telephone_number": "704-921-9279",
            "fax_number": "704-896-1978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTON HOUSE I, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "NORMAN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "704-895-3645",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "NC",
            "license": "HAL060031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kimberly Reynolds Pretty, LCAS, LCMHC

• Alzheimer Center (Dementia Center) in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Alzheimer Center (Dementia Center) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.