NPIMap

Organization Active NPI

Ellison'S Family Care Home3

  • Assisted Living Facility
  • Reidsville, NC
National Provider Identifier
1659596575
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
FCL-017-029 Issued in NC
Legal business name
ELLISON'S FAMILY CARE HOME3
Practice address
31 Alex Poteat Rd
Reidsville, NC 27320-9741
Phone
(336) 634-1332
Fax
(336) 349-2273
NPI assigned
Apr 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Clarissa B Ellison
Title
Administrator
Phone
(336) 349-2220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X FCL-017-029 NC Primary

Addresses

Primary practice location

31 Alex Poteat Rd
Reidsville, NC 27320-9741

Mailing address

PO Box 1316
Reidsville, NC 27323-1316
Phone (336) 349-2220

Other identifiers 1

IdentifierTypeStateIssuer
7803270MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Ellison'S Family Care Home3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1659596575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1316",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273231316",
            "telephone_number": "336-349-2220",
            "fax_number": "336-349-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 ALEX POTEAT RD",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273209741",
            "telephone_number": "336-634-1332",
            "fax_number": "336-349-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLISON'S FAMILY CARE HOME3",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ELLISON",
        "authorized_official_first_name": "CLARISSA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "336-349-2220",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "FCL-017-029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7803270",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reidsville, NC

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.