Creekside Manor of Forsyth, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

HAL-034-060 Issued in NC

Legal business name

CREEKSIDE MANOR OF FORSYTH, LLC

Practice address

6206 Reidsville Rd
Kernersville, NC 27284-7609

Phone

(336) 722-6054

NPI assigned

Oct 26, 2006

Organization subpart

No

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

Authorized official

Name

Candace P Hammonds

Title

Managing Member

Phone

(336) 595-6004

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376628735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1487",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272851487",
            "telephone_number": "336-595-1075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6206 REIDSVILLE RD",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847609",
            "telephone_number": "336-722-6054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE MANOR OF FORSYTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HAMMONDS",
        "authorized_official_first_name": "CANDACE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "336-595-6004"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL-034-060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804346",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Kernersville, NC
• Providers in Kernersville, 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 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.