Clemmons Assisted Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

HAL-034-062 Issued in NC

Legal business name

CLEMMONS ASSISTED LIVING LLC

Doing business as

Clemmons Village II

Practice address

6441 Holder Rd
Clemmons, NC 27012-9207

Phone

(336) 778-8548

Fax

(336) 778-8875

NPI assigned

Oct 27, 2006

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

Aldo Baccala

Title

Owner / Manager

Phone

(707) 778-6713

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Clemmons Village II Doing business as

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": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649355439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6441 HOLDER RD",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270129207",
            "telephone_number": "336-778-8548",
            "fax_number": "336-778-8875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6441 HOLDER RD",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270129207",
            "telephone_number": "336-778-8548",
            "fax_number": "336-778-8875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEMMONS ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BACCALA",
        "authorized_official_first_name": "ALDO",
        "authorized_official_title_or_position": "OWNER / MANAGER",
        "authorized_official_telephone_number": "707-778-6713"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL-034-062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804691",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clemmons Village II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marissa Christian, RBT
• Bradley Walton Clark, MD
• Joanne Clarkin Gonzalez, SLP
• Kevin Joseph Cleary, P.T.
• Alyssa Laura Clements, PH.D.
• Clemmons Dermatology
• Clemmons Family Eye Care
• Clemmons Psychiatric Associates
• Clemmons Road Operating Company, LLC (Cedar Hills Center for Nursing and Rehabilitation)
• Clemmons Urgent and Primary Care, PA

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