Pigeon Valley Rest Home LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

HAL044012 Issued in NC

Legal business name

PIGEON VALLEY REST HOME LLC

Practice address

55 Lake Dr
Canton, NC 28716-9312

Phone

(828) 648-2044

Fax

(828) 648-2065

NPI assigned

Aug 31, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Bobby N Leatherwood

Title

Administrator

Phone

(828) 648-2044

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1528051935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SILVER BLUFF DR",
            "city": "CANTON",
            "state": "NC",
            "postal_code": "287166350",
            "telephone_number": "828-648-2044",
            "fax_number": "828-648-2065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LAKE DR",
            "city": "CANTON",
            "state": "NC",
            "postal_code": "287169312",
            "telephone_number": "828-648-2044",
            "fax_number": "828-648-2065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIGEON VALLEY REST HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LEATHERWOOD",
        "authorized_official_first_name": "BOBBY",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "828-648-2044",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "HAL044012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7801751",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles Richard Panther, MSW, LCSW
• Susan E Partlow, LMBT
• Peak Physical Therapy & Rehabilitation Inc
• Gabriella Pennell
• Amy Perlow, D.M.D.
• Premise Health of North Carolina Medical, P.C
• Premise Health of North Carolina Medical, P.C
• Morgan Cara Presnell
• Isaac Gabriel Quilhot, DDS
• Katie Ann Rainwater

• Adult Care Home Facility in Canton, NC
• Providers in Canton, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.