Luby-Jay Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

HAL-036-005 Issued in NC

Legal business name

LUBY-JAY INC

Doing business as

South Haven Long Term Care

Practice address

916 S Marietta St
Gastonia, NC 28054-5405

Phone

(704) 830-1101

NPI assigned

Mar 26, 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

Holly Gause

Title

Administrator

Phone

(704) 830-1101

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• South Haven Long Term Care Doing business as

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1518085935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1678",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270121678",
            "telephone_number": "336-998-5001",
            "fax_number": "336-998-5470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 S MARIETTA ST",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280545405",
            "telephone_number": "704-830-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUBY-JAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GAUSE",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "704-830-1101"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL-036-005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7801358",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Haven Long Term Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Craig F Lowry, DMD
• Keith W Lowry
• Stephanie D Lowry, DMD
• LP Gastonia, LLC (Gastonia Care and Rehabilitation)
• Margaret Lubega, M.D.
• Donna H Lucas, CRNA
• Lisa Lunceford Lucas, NP
• Carmelita Jasmine Lugue, DO
• Lumina One Life Center
• Michael James Lund, M.D.

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