Heritage Creek Family Care Estate

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

FCL-052-005 Issued in NC

Legal business name

HERITAGE CREEK FAMILY CARE ESTATE

Practice address

1662 Small Town Rd
Pink Hill, NC 28572-9625

Phone

(252) 568-2655

Fax

(252) 568-2658

NPI assigned

Aug 31, 2006

Last updated

Jun 25, 2011By 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. Joseph M Newsome

Title

Director of Medicaid Billing

Phone

(252) 525-1082

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308960000000",
    "number": "1669584298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1662 SMALL TOWN RD",
            "city": "PINK HILL",
            "state": "NC",
            "postal_code": "285729625",
            "telephone_number": "252-568-2655",
            "fax_number": "252-568-2658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1662 SMALL TOWN RD",
            "city": "PINK HILL",
            "state": "NC",
            "postal_code": "285729625",
            "telephone_number": "252-568-2655",
            "fax_number": "252-568-2658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE CREEK FAMILY CARE ESTATE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2011-06-25",
        "status": "A",
        "authorized_official_last_name": "NEWSOME",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR OF MEDICAID BILLING",
        "authorized_official_telephone_number": "252-525-1082",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "FCL-052-005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Pink Hill, NC
• Providers in Pink Hill, 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 Jun 25, 2011; 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.