Waterside Healthcare Inc.

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

HAL-010-004 Issued in NC

Legal business name

WATERSIDE HEALTHCARE INC.

Doing business as

Shallotte Assisted Living

Practice address

520 Mulberry St
Shallotte, NC 28470-4586

Phone

(910) 754-6621

NPI assigned

Feb 3, 2007

Organization subpart

No

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

President

Phone

(910) 754-6621

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shallotte Assisted Living Doing business as

Tax ID family

Shallotte Assisted Living2 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.

• Waterside Healthcare Inc.

  dba Waterbrooke Assisted Living

  • Adult Care Home Facility
  • Tabor City, NC
  • NPI 1992843577
  NPD tax ID

Locations

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": "1467590042",
    "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": "520 MULBERRY ST",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284704586",
            "telephone_number": "910-754-6621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERSIDE HEALTHCARE INC.",
        "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": "PRESIDENT",
        "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": "HAL-010-004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805372",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shallotte Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Aaron Scott Ward, DDS
• John David Ward, D.D.S.
• Marcus Brian Ward, D.M.D
• Abigail Cristine Warren, DMD
• Susan Diane Warren, MSW, LCSW
• Melissa Buckner Wayne, NP-C
• Debra C Webb, OD
• Monique Weddle, D.C.
• Brooke Malanga Weissman, MPT
• Gwen Weller, FNP-C

• Adult Care Home Facility in Shallotte, NC
• Providers in Shallotte, 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.