NPIMap

Organization Active NPI

Dixie Rest Home 1

Doing business as Woodhaven Rest Home 1

  • Assisted Living Facility
  • Enfield, NC
National Provider Identifier
1417028135
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
HAL042002 Issued in NC
Legal business name
DIXIE REST HOME 1
Doing business as
Woodhaven Rest Home 1
Practice address
310 North Martin Luther King Avenue
Enfield, NC 27823
Phone
(252) 445-5665
Fax
(252) 445-3466
NPI assigned
Nov 13, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Ronald W Wood, PRESIDENT
Title
Administrator
Phone
(252) 445-5665

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X HAL042002 NC Primary

Addresses

Primary practice location

310 North Martin Luther King Avenue
Enfield, NC 27823

Mailing address

PO Box 129
310 North Martin Luther King Avenue
Enfield, NC 27823
Phone (252) 445-5665

Other identifiers 1

IdentifierTypeStateIssuer
7801459MedicaidNC

Other names 1

  • Woodhaven Rest Home 1 Doing business as

National Provider Directory

National Provider Directory

Locations

310 N Martin Luther King Ave
Enfield, NC 27823
Phone (252) 445-5665

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.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417028135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 129",
            "address_2": "310 NORTH MARTIN LUTHER KING AVENUE",
            "city": "ENFIELD",
            "state": "NC",
            "postal_code": "27823",
            "telephone_number": "252-445-5665",
            "fax_number": "252-445-3466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 NORTH MARTIN LUTHER KING AVENUE",
            "city": "ENFIELD",
            "state": "NC",
            "postal_code": "27823",
            "telephone_number": "252-445-5665",
            "fax_number": "252-445-3466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIXIE REST HOME 1",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "252-445-5665",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PRESIDENT"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL042002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7801459",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodhaven Rest Home 1",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Enfield, NC

Sources for this page

  • 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.