NPIMap

Organization Active NPI

Genuwinepersonalcare

  • Exclusive Provider Organization
  • Winston Salem, NC
National Provider Identifier
1508902701
Registry record updated Jul 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Exclusive Provider OrganizationTaxonomy code 302F00000X
Legal business name
GENUWINEPERSONALCARE
Practice address
3305 Stockton St
Winston Salem, NC 27127-5135
Phone
(336) 499-7113
Fax
(336) 650-1057
NPI assigned
Jan 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2009

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

Authorized official

Name
Mrs. Audrey Jean Williams
Title
Owner
Phone
(336) 499-7113

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Exclusive Provider Organization 302F00000X NC Primary

Addresses

Primary practice location

3305 Stockton St
Winston Salem, NC 27127-5135

Mailing address

3305 Stockton St
Winston Salem, NC 27127-5135
Phone (336) 499-7113

Other identifiers 3

IdentifierTypeStateIssuer
3408562MedicaidNC
8301733MedicaidNC
8301526MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Genuwine Personal Care LLC3 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.

Locations

3305 Stockton St
Winston Salem, NC 27127
Phone (336) 499-7113

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247702400000",
    "number": "1508902701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3305 STOCKTON ST",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271275135",
            "telephone_number": "336-499-7113",
            "fax_number": "336-650-1057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3305 STOCKTON ST",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271275135",
            "telephone_number": "336-499-7113",
            "fax_number": "336-650-1057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENUWINEPERSONALCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2009-07-16",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-499-7113",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3408562",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301733",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301526",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2009; 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.