Fve SE Wilson LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

HAL-098-029 Issued in NC

Legal business name

FVE SE WILSON LLC

Doing business as

Parkwood Village

Practice address

1730 Parkwood Blvd W
Wilson, NC 27893-3564

Phone

(252) 237-9050

Fax

(252) 237-9093

NPI assigned

Jul 18, 2011

Organization subpart

No

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

Authorized official

Name

Katherine E Potter

Title

President & Chief Executive Officer

Phone

(617) 796-8387

Specialties & licenses 1

Addresses

Other names 1

• Parkwood Village Doing business as

Locations

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

{
    "created_epoch": "1310947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553731200000",
    "number": "1619265261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 CENTRE ST",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "024582094",
            "telephone_number": "617-796-8387",
            "fax_number": "617-796-8385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 PARKWOOD BLVD W",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278933564",
            "telephone_number": "252-237-9050",
            "fax_number": "252-237-9093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FVE SE WILSON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-18",
        "last_updated": "2019-03-28",
        "status": "A",
        "authorized_official_last_name": "POTTER",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT & CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "617-796-8387"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL-098-029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parkwood Village",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Parkwood Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Samantha Renee Freeman
• Franklyn Jeremy Frias, DDS
• Brittany Wooten Fulghum, AGNP
• Fullers Home Health Care Inc
• Carl Augustus Furr III, DDS
• Zizette M Gabriel, MD
• Christopher Michael Gal, M.D.
• Lee Caitlin San Pedro Garcia
• Angela Katherine Gates Daquila, BSN, RN
• Stacy Ann Gay, MS, CCC-SLP

• Assisted Living Facility in Wilson, NC
• Providers in Wilson, 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 Mar 28, 2019; 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.