Classic Care Homes 105

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

HAL-051-020 Issued in NC

Legal business name

CLASSIC CARE HOMES 105

Practice address

105 Annie Parker Cir
Smithfield, NC 27577-3968

Phone

(919) 934-8976

Fax

(919) 934-8976

NPI assigned

Feb 5, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Diane Hollamon

Title

Administrator

Phone

(919) 934-8976

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Classic Care Homes3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Classic Care Homes

  • Assisted Living Facility
  • Smithfield, NC
  • NPI 1417002445
  NPD tax ID
• Classic Care Homes 103

  • Assisted Living Facility
  • Smithfield, NC
  • NPI 1659418846
  NPD tax ID

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437298783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 ANNIE PARKER CIR",
            "city": "SMITHFIELD",
            "state": "NC",
            "postal_code": "275773968",
            "telephone_number": "919-934-8976",
            "fax_number": "919-934-8976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 ANNIE PARKER CIR",
            "city": "SMITHFIELD",
            "state": "NC",
            "postal_code": "275773968",
            "telephone_number": "919-934-8976",
            "fax_number": "919-934-8976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLASSIC CARE HOMES 105",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLLAMON",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "919-934-8976",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL-051-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7803023",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Classic Care Holdings LLC (Classic Care Holdings)
• Classic Care Holdings LLC (Classic Care Holdings 103)
• Classic Care Holdings LLC (Classic Care Homes 105)
• Classic Care Homes
• Classic Care Homes 103
• Lisa Jo Clemens, MA, LCMHC
• Clemson Sports Medicine and Rehabilitation, Inc. (Sports Plus)
• Kristine Danielle Cleveland
• Joseph Tucker Cline, MD
• Coates Hearing Clinic, PA

• Assisted Living Facility in Smithfield, NC
• Providers in Smithfield, 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.