Statesville Assisted Living, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

HAL049023 Issued in NC

Legal business name

STATESVILLE ASSISTED LIVING, LLC

Doing business as

The Gardens of Statesville

Practice address

2147 Davie Ave
Statesville, NC 28625-9200

Phone

(704) 878-0123

Fax

(704) 878-8689

NPI assigned

May 22, 2007

Last updated

Aug 31, 2007By 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

Mr. Eric Hadley, MHA, NHA, FACHE

Title

VP of Operations

Phone

(704) 878-0123

Specialties & licenses 1

Addresses

Other names 1

• The Gardens of Statesville 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

Tax ID family

Statesville Assisted Living2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Statesville Assisted Living

  • Preferred Provider Organization
  • Statesville, NC
  • NPI 1124191804
  NPD tax ID

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188518400000",
    "number": "1659580819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2147 DAVIE AVE",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286259200",
            "telephone_number": "704-878-0123",
            "fax_number": "704-878-8689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2147 DAVIE AVE",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286259200",
            "telephone_number": "704-878-0123",
            "fax_number": "704-878-8689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATESVILLE ASSISTED LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2007-08-31",
        "status": "A",
        "authorized_official_last_name": "HADLEY",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "704-878-0123",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MHA, NHA, FACHE"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL049023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Gardens of Statesville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy Stamper
• Adam Stapleton, PA-C
• Jessica Starr, ATC
• Statesville Amy Kinlaw PLLC (Iredell Pediatric Dentistry)
• Statesville Assisted Living
• Statesville Cardiovascular Clinic PA
• Statesville Childrens Clinic PA
• Statesville Dialysis Center of Wake Forest University (Statesville Dialysis Center)
• Statesville Hma Inc (Davis Regional Medical Center)
• Statesville Hma LLC (Davis Regional Medical Center)

• Assisted Living Facility in Statesville, NC
• Providers in Statesville, 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 31, 2007; 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.