Active NPI
The Cardinal at North Hills Healthcare, LLC
- Assisted Living Facility
- Raleigh, NC
National Provider Identifier
1407227382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- Legal business name
- THE CARDINAL AT NORTH HILLS HEALTHCARE, LLC
- Practice address
- 311 Garden at North Hills
Raleigh, NC 27609 - Phone
- (760) 804-5900
- NPI assigned
- Oct 16, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Terri Novak
- Title
- Vice President
- Phone
- (760) 804-5900
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | Primary | ||
| Alzheimer Center (Dementia Center) | 311500000X | |||
| Skilled Nursing Facility | 314000000X |
Addresses
Primary practice location
311 Garden at North Hills
Raleigh, NC 27609
Mailing address
5790 Fleet St
Suite 300
Carlsbad, CA 92008-4703
Phone (760) 804-5900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161215000184 | NC | Part A Provider - Skilled Nursing Facility | 0547540296 | Practice locations: Raleigh, NC |
Skilled nursing facility certification: CCN 345572
- Legal name
- THE CARDINAL AT NORTH HILLS HEALTHCARE, LLC
- Doing business as
- THE CARDINAL AT NORTH HILLS
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF (Medicare) only
- Participating since
- Jun 28, 2017
- Last certification
- Sep 19, 2024
- Beds
- 15
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Kisco Senior Living
- Organization structure
- LLC
- Incorporated
- Feb 12, 2008 in NC
- Enrollment address
- 311 Garden at North Hills
Raleigh, NC 27609 - Nursing home name
- THE CARDINAL AT NORTH HILLS
- Affiliated entity
- KISCO SENIOR LIVING
Care Compare: Nursing home
Medicare Care Compare- Listed as
- The Cardinal at North Hills
- Overall star rating
- Health inspections
- Quality measures
- Type
- Medicare
- Ownership
- For profit - Limited Liability company
- Certified
- Jun 28, 2017
- Medicare certification status
- Active
- Certified beds
- 15
- Chain
- Kisco Senior Living
- Penalties (3 years)
- 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2126487 | Cardinal at North Hills Healthcare, LLC | Certificate of waiver | Feb 27, 2027 |
National Provider Directory
National Provider DirectoryLocations
5790 Fleet St
Ste 300
Carlsbad, CA 92008
Ownership & related parties
All disclosed owners & managing parties 4
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Scott Kohlberg | 5% Or Greater Direct Ownership Interest | Jan 1, 2013 | |
| Breck Austin | Corporate Officer | Jan 1, 2013 | |
| W-2 Managing Employee | Jan 1, 2013 | ||
| Mitchell Ritschel | Corporate Officer | Dec 1, 2012 | |
| Jaime Pacheco | W-2 Managing Employee | Nov 24, 2022 | 100% |
Practitioners & affiliated clinicians
Affiliated clinicians 2
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Geriatric Medicine (Internal Medicine) Physician
- Durham, NC
- NPI 1811152804
Nursing home
-
- Geriatric Medicine (Family Medicine) Physician
- Raleigh, NC
- NPI 1932384955
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444953600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1445904000000",
"number": "1407227382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5790 FLEET ST",
"address_2": "SUITE 300",
"city": "CARLSBAD",
"state": "CA",
"postal_code": "920084703",
"telephone_number": "760-804-5900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "311 GARDEN AT NORTH HILLS",
"city": "RALEIGH",
"state": "NC",
"postal_code": "27609",
"telephone_number": "760-804-5900"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "THE CARDINAL AT NORTH HILLS HEALTHCARE, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-10-16",
"last_updated": "2015-10-27",
"status": "A",
"authorized_official_last_name": "NOVAK",
"authorized_official_first_name": "TERRI",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "760-804-5900"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": null,
"license": null,
"primary": true
},
{
"code": "311500000X",
"taxonomy_group": "",
"desc": "Alzheimer Center (Dementia Center)",
"state": null,
"license": null,
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Raleigh, NC
- The Bruson Group Inc.
- The Bruson Group Inc.,
- The Bruson Group Inc., Dba New Beginning'S Health Care
- The Bruson Group, Inc.
- The Butterfly Effect Center for Wellness
- The Carter Clinic,PA
- The Centre for Healing and Enlightenment
- The Composition Dietitian
- The Cypress of Raleigh Club, Inc.
- The Cypress of Raleigh, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.