Active NPI
Stanley Total Living Center, Inc
- Skilled Nursing Facility
- Stanley, NC
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- NH0386
- Legal business name
- STANLEY TOTAL LIVING CENTER, INC
- Practice address
- 514 Old Mount Holly Rd
Stanley, NC 28164-2191 - Phone
- (704) 263-1986
- Fax
- (704) 263-8959
- NPI assigned
- Sep 29, 2005
- Last updated
- Nov 19, 2009
- 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
- Mrs. Jennifer Defelice, RN
- Title
- Administrator
- Phone
- (704) 263-1986
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Alzheimer Center (Dementia Center) | 311500000X | NH0386 | NC | |
| Adult Care Home Facility | 311ZA0620X | NH0386 | NC | |
| Nursing Facility/Intermediate Care Facility | 313M00000X | NH0386 | NC | |
| Skilled Nursing Facility | 314000000X | NH0386 | NC | Primary |
Addresses
Primary practice location
514 Old Mount Holly Rd
Stanley, NC 28164-2191
Mailing address
PO Box 489
Stanley, NC 28164-0489
Phone (704) 263-1986
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3405264 | Medicaid | NC | |
| 0086C | Other | NC | PROVIDER NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040205000805 | NC | Part A Provider - Skilled Nursing Facility | 1456244102 | Practice locations: Stanley, NC |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1407843097. Details of each certification follow.
Skilled nursing facility certification: CCN 345264
- Legal name
- STANLEY TOTAL LIVING CENTER, INC
- Doing business as
- STANLEY TOTAL LIVING CENTER, INC
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- Jul 23, 1987
- Last certification
- Oct 25, 2024
- Beds
- 146 (106 certified)
- Ownership / control type
- Corporation
- Organization structure
- Corporation
- Incorporated
- Jan 19, 1981 in NC
- Enrollment address
- 514 Old Mount Holly Rd
Stanley, NC 28164-2191 - Nursing home name
- STANLEY TOTAL LIVING CENTER
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Stanley Total Living Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jul 23, 1987
- Medicare certification status
- Active
- Certified beds
- 106
- Penalties (3 years)
- 1
National Provider Directory
National Provider Directory- Tax ID family
- Stanley Total Living Center
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Adult Care Home Facility
- Stanley, NC
- NPI 1669656047
-
- Nursing Facility/Intermediate Care Facility
- Stanley, NC
- NPI 1932383312
Ownership & related parties
All disclosed owners & managing parties 18
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 |
|---|---|---|---|
| Dana H Baker | Corporate Director | Jan 1, 2022 | 5.88% |
| Cathy H Kirkland | Corporate Director | Mar 1, 2021 | 5.88% |
| John D Nelson | Adp of the SNF | Jan 1, 2010 | |
| Sharon Bryant | Corporate Officer | Mar 31, 2008 | |
| Adp of the SNF | Mar 31, 2008 | ||
| Melissa Smith | Corporate Director | Oct 1, 2008 | 5.88% |
| Rob McMinn | Corporate Officer | Jan 1, 2013 | 5.88% |
| Corporate Director | Jan 1, 2012 | 5.88% | |
| Teresa Neely | Corporate Director | Oct 1, 2008 | 5.88% |
| Jennifer Defelice | Corporate Director | Jan 1, 2022 | 5.88% |
| Operational/Managerial Control | Oct 1, 2008 | ||
| Adp of the SNF | Oct 1, 2008 | ||
| Allison D Crotts | Corporate Officer | Jan 1, 2018 | 5.88% |
| Corporate Director | Oct 1, 2015 | 5.88% | |
| Elizabeth M Grice | Corporate Director | Jan 1, 2019 | 5.88% |
| Steve Smith | Corporate Officer | Jun 7, 2013 | 5.88% |
| Derrick a Gantt | Corporate Director | Jan 5, 2023 | 5.88% |
| Kevin G Mauney | Corporate Director | Jan 1, 2019 | 5.88% |
| Ronnie Ensley | Corporate Officer | Oct 1, 2008 | 5.88% |
| Judith Abernathy | Corporate Director | Jul 1, 2013 | 5.88% |
| Sandra Denise Mull | Adp of the SNF | Jul 16, 1997 | |
| Deborah M Harper | Corporate Director | Jan 26, 2015 | 5.88% |
| Teresa West | Corporate Director | Oct 1, 2008 | 5.88% |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Family Medicine Physician
- Asheville, NC
- NPI 1528047248
Affiliated clinicians 2
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127952000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1258588800000",
"number": "1407843097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 489",
"city": "STANLEY",
"state": "NC",
"postal_code": "281640489",
"telephone_number": "704-263-1986",
"fax_number": "704-263-8959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "514 OLD MOUNT HOLLY RD",
"city": "STANLEY",
"state": "NC",
"postal_code": "281642191",
"telephone_number": "704-263-1986",
"fax_number": "704-263-8959"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "STANLEY TOTAL LIVING CENTER, INC",
"organizational_subpart": "NO",
"enumeration_date": "2005-09-29",
"last_updated": "2009-11-19",
"status": "A",
"authorized_official_last_name": "DEFELICE",
"authorized_official_first_name": "JENNIFER",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "704-263-1986",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "RN"
},
"taxonomies": [
{
"code": "311500000X",
"taxonomy_group": "",
"desc": "Alzheimer Center (Dementia Center)",
"state": "NC",
"license": "NH0386",
"primary": false
},
{
"code": "311ZA0620X",
"taxonomy_group": "",
"desc": "Custodial Care Facility, Adult Care Home",
"state": "NC",
"license": "NH0386",
"primary": false
},
{
"code": "313M00000X",
"taxonomy_group": "",
"desc": "Nursing Facility/Intermediate Care Facility",
"state": "NC",
"license": "NH0386",
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NC",
"license": "NH0386",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3405264",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROVIDER NUMBER",
"identifier": "0086C",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Stanley, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2009; 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.