Tillery'S Place, LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

FCL-064-030 Issued in NC

Legal business name

TILLERY'S PLACE, LLC

Practice address

200 S Tillery St
Rocky Mount, NC 27804-5527

Phone

(252) 446-6613

NPI assigned

Aug 18, 2015

Organization subpart

No

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

Authorized official

Name

Miss Shavonnie Deans

Title

Owner

Phone

(252) 446-6613

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1439856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439856000000",
    "number": "1386010908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S TILLERY ST",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278045527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S TILLERY ST",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278045527",
            "telephone_number": "252-446-6613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TILLERY'S PLACE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-18",
        "last_updated": "2015-08-18",
        "status": "A",
        "authorized_official_last_name": "DEANS",
        "authorized_official_first_name": "SHAVONNIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-446-6613",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "FCL-064-030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Rocky Mount, NC
• Providers in Rocky Mount, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; 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.