CCJ Adult Care V LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

CCJ ADULT CARE V LLC

Practice address

630 Sugar Hill Rd
Lawndale, NC 28090-9493

Phone

(980) 295-3020

Fax

(704) 406-9372

NPI assigned

Sep 22, 2025

Organization subpart

No

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

Authorized official

Name

Bernice R Hosch

Title

Administrator/Operator

Phone

(980) 295-3020

Specialties & licenses 1

Addresses

Other names 1

• Golden Years Rest Home Doing business as

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

{
    "created_epoch": "1758499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778025600000",
    "number": "1629940291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 W MAIN AVE APT 302",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280524172",
            "telephone_number": "980-295-3020",
            "fax_number": "704-406-9372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 SUGAR HILL RD",
            "city": "LAWNDALE",
            "state": "NC",
            "postal_code": "280909493",
            "telephone_number": "980-295-3020",
            "fax_number": "704-406-9372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCJ ADULT CARE V LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-22",
        "last_updated": "2026-05-06",
        "certification_date": "2026-05-06",
        "status": "A",
        "authorized_official_last_name": "HOSCH",
        "authorized_official_first_name": "BERNICE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR/OPERATOR",
        "authorized_official_telephone_number": "980-295-3020"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Golden Years Rest Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Megan Elizabeth Kent Baker, LCSW
• Emily Barnett, BCBA
• Betty G Wellmon
• Ted Freemon Cash, MD
• CCJ Adult Care II LLC
• CCJ Adult Care VL LLC
• Cleco Primary Care Network
• Ashby Kaylin Dellinger, DNP,FNP-C
• Elizabeth Ann Elliott
• Focus Family Care Home

• All providers in Lawndale, NC
• Assisted Living Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2026; 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.