NPIMap

Organization Active NPI

Ser

  • Adult Care Home Facility
  • Shelby, NC
National Provider Identifier
1659636173
Registry record updated Jul 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
Legal business name
SER
Practice address
208 Leslie Dr
Shelby, NC 28152-0758
Phone
(704) 600-6480
Fax
(704) 600-6480
NPI assigned
Jul 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2012

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

Authorized official

Name
Mr. Marickeyo Sentwan Huskey
Title
Administrator
Phone
(704) 600-6710

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X NC Primary

Addresses

Primary practice location

208 Leslie Dr
Shelby, NC 28152-0758

Mailing address

208 Leslie Dr
Shelby, NC 28152-0758
Phone (704) 600-6480

National Provider Directory

National Provider Directory
Tax ID family
Ser2 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.

NPI Registry JSON

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

{
    "created_epoch": "1341878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341878400000",
    "number": "1659636173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 LESLIE DR",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281520758",
            "telephone_number": "704-600-6480",
            "fax_number": "704-600-6480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 LESLIE DR",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281520758",
            "telephone_number": "704-600-6480",
            "fax_number": "704-600-6480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-10",
        "last_updated": "2012-07-10",
        "status": "A",
        "authorized_official_last_name": "HUSKEY",
        "authorized_official_first_name": "MARICKEYO",
        "authorized_official_middle_name": "SENTWAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "704-600-6710",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2012; 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.