Shelby Opco, LLC

Key facts

NPI

1689171431

Entity type

Organization (NPI type 2)

Primary specialty

Adult Care Home Facility 311ZA0620X

Legal business name

SHELBY OPCO, LLC

Practice address

1176 Wyke Rd
Shelby, NC 28150-4273

Phone

(704) 482-0000

NPI assigned

Apr 9, 2018

Organization subpart

No

Authorized official

Name

Charles E Trefzger

Title

Manager

Phone

(828) 322-5535

National Provider Directory

Specialties & licenses

Addresses

Other names

• Shelby Manor Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 9, 2021.

{
    "created_epoch": "1523232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636416000000",
    "number": "1689171431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2568",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286032568",
            "telephone_number": "828-322-5535",
            "fax_number": "828-326-8109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1176 WYKE RD",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281504273",
            "telephone_number": "704-482-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELBY OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-09",
        "last_updated": "2021-11-09",
        "certification_date": "2021-11-09",
        "status": "A",
        "authorized_official_last_name": "TREFZGER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "828-322-5535"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL023046",
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shelby Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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All providers in Shelby, NC · Adult Care Home Facility in North Carolina