Mt. Olive Family Care Home

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

FCL-024-002 Issued in NC

Legal business name

MT. OLIVE FAMILY CARE HOME

Practice address

2583 Red Store Rd
Whiteville, NC 28472-6831

Phone

(910) 648-4946

NPI assigned

Mar 1, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Willie Edward Spruill

Title

Administrator

Phone

(910) 628-7755

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Mt Olive Family Care Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Mt. Olive Family Care Home #2

  • Adult Care Home Facility
  • Fairmont, NC
  • NPI 1700914595
  NPD tax ID

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467580241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 JACKSON ST",
            "city": "FAIRMONT",
            "state": "NC",
            "postal_code": "283401621",
            "telephone_number": "910-628-7755",
            "fax_number": "910-628-7755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2583 RED STORE RD",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284726831",
            "telephone_number": "910-648-4946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT. OLIVE FAMILY CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SPRUILL",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "910-628-7755",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "FCL-024-002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7801519",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monique Mary Moona, MD
• Briana Page Moore, PHARMD
• Lynn Rich Moore, LPN
• Brice Alan Morey, DO
• Shannon Kathleen Morgan-Baehr, CRNA
• Tiffany Monique Mullins, LCMHC-A
• Joanne Caroline Murphy, PA-C
• Andrea J Nance, MED CCC-SLP
• National Mentor Healthcare, LLC (NC Mentor)
• National Mentor Healthcare, LLC (NC Mentor)

• Adult Care Home Facility in Whiteville, NC
• Providers in Whiteville, NC by specialty
• Adult Care Home 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.