Carolina Mountain Dda Group Home

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

MHL-011-229 Issued in NC

Legal business name

CAROLINA MOUNTAIN DDA GROUP HOME

Practice address

82 Daniel Ridge Road
Candler, NC 28715

Phone

(828) 665-6578

NPI assigned

Jun 20, 2007

Last updated

Aug 22, 2020By 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

Ms. Mildred L Reece

Title

President

Phone

(828) 665-6578

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Carolina Mountain Dda Group Home2 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.

• Carolina MTN Dda

  • Adult Care Home Facility
  • Candler, NC
  • NPI 1023139417
  NPD tax ID

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

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679778310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1311",
            "city": "CANDLER",
            "state": "NC",
            "postal_code": "287151311",
            "telephone_number": "828-665-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 DANIEL RIDGE ROAD",
            "city": "CANDLER",
            "state": "NC",
            "postal_code": "28715",
            "telephone_number": "828-665-6578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA MOUNTAIN DDA GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REECE",
        "authorized_official_first_name": "MILDRED",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "828-665-6578",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "MHL-011-229",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804613",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Craig Marshall Burnworth, M.D.
• Candler Living Center LLC
• Joseph Nelson Carcamo
• Care Medical, Inc.
• Carolina Adventist Retirement Systems, Inc. (Pisgah Manor Health Care Center)
• Carolina Mountain Pharmacy Inc (Carolina Mountain Pharmacy)
• Carolina MTN Dda
• Carolina Vision Optometrists PLLC
• Amanda Carroll
• Mayka Chaves, PHARMD

• Adult Care Home Facility in Candler, NC
• Providers in Candler, NC by specialty
• Adult Care Home Facility in North Carolina

• 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.