NPIMap

Organization Active NPI

DBG III LLC

Doing business as Fair Bluff Assisted Living #1

  • Adult Care Home Facility
  • Fair Bluff, NC
National Provider Identifier
1447398029
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
FCL-024-005 Issued in NC
Legal business name
DBG III LLC
Doing business as
Fair Bluff Assisted Living #1
Practice address
225 Minton St
Fair Bluff, NC 28439-9590
Phone
(910) 754-6621
NPI assigned
Feb 3, 2007
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. David B Goldston III
Title
Manager
Phone
(910) 754-6621

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X FCL-024-005 NC Primary

Addresses

Primary practice location

225 Minton St
Fair Bluff, NC 28439-9590

Mailing address

PO Box 1559
Shallotte, NC 28459-1559
Phone (910) 754-6621

Other identifiers 1

IdentifierTypeStateIssuer
7805470MedicaidNC

Other names 1

  • Fair Bluff Assisted Living #1 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Indiana Health Coverage Program6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

225 Minton St
Fair Bluff, NC 28439
Phone (910) 754-6621

NPI Registry JSON

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

{
    "created_epoch": "1170460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447398029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1559",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284591559",
            "telephone_number": "910-754-6621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 MINTON ST",
            "city": "FAIR BLUFF",
            "state": "NC",
            "postal_code": "284399590",
            "telephone_number": "910-754-6621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DBG III LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GOLDSTON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "910-754-6621",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "FCL-024-005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805470",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fair Bluff Assisted Living #1",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fair Bluff, 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.