NPIMap

Organization Active NPI

Glencare Assisted Living, Inc.

Doing business as Glencare of Holly Ridge

  • Assisted Living Facility
  • Holy Ridge, NC
National Provider Identifier
1679612642
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
HAL067015 Issued in NC
Legal business name
GLENCARE ASSISTED LIVING, INC.
Doing business as
Glencare of Holly Ridge
Practice address
3255 Sound Road
Holy Ridge, NC 28445-0157
Phone
(910) 329-9941
Fax
(910) 329-9943
NPI assigned
Feb 6, 2007
Last updated
Aug 22, 2020By the provider in NPPES
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. Marian Anne Kornegay, R.N. NHA V.P.
Title
Vice President
Phone
(910) 275-0058

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X HAL067015 NC Primary

Addresses

Primary practice location

3255 Sound Road
Holy Ridge, NC 28445-0157

Mailing address

PO Box 339
Kenansville, NC 28349-0339
Phone (910) 275-0058

Other identifiers 1

IdentifierTypeStateIssuer
7805699MedicaidNC

Other names 1

  • Glencare of Holly Ridge Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Glencare Assisted Living Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679612642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 339",
            "city": "KENANSVILLE",
            "state": "NC",
            "postal_code": "283490339",
            "telephone_number": "910-275-0058",
            "fax_number": "910-275-0093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3255 SOUND ROAD",
            "city": "HOLY RIDGE",
            "state": "NC",
            "postal_code": "284450157",
            "telephone_number": "910-329-9941",
            "fax_number": "910-329-9943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENCARE ASSISTED LIVING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KORNEGAY",
        "authorized_official_first_name": "MARIAN",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "910-275-0058",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N. NHA V.P."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL067015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805699",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glencare of Holly Ridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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.