C.R.T. Golden Lamb Rest Home, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

HAL-034-019 Issued in NC

Legal business name

C.R.T. GOLDEN LAMB REST HOME, INC.

Practice address

1515 Golden Lamb CT
Winston Salem, NC 27105-6700

Phone

(336) 727-9119

Fax

(336) 727-1128

NPI assigned

Mar 29, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Willie Davis Jr.

Title

Ceo

Phone

(336) 727-9119

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386763266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16304",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271156304",
            "telephone_number": "336-727-9119",
            "fax_number": "336-727-1128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 GOLDEN LAMB CT",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271056700",
            "telephone_number": "336-727-9119",
            "fax_number": "336-727-1128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C.R.T. GOLDEN LAMB REST HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "336-727-9119",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL-034-019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7801856",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Winston Salem, NC
• Providers in Winston Salem, 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.