NPIMap

Organization Active NPI

Gavin & Downey Heavenly Living Home #3

  • Adult Care Home Facility
  • Norlina, NC
National Provider Identifier
1689994709
Registry record updated Jun 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
MHL-093-055 Issued in NC
Legal business name
GAVIN & DOWNEY HEAVENLY LIVING HOME #3
Practice address
426 Rooker Dairy Rd
Norlina, NC 27563-9544
Phone
(252) 456-9996
Fax
(252) 456-2027
NPI assigned
Jun 11, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2010

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

Authorized official

Name
Ms. Ann Lois Gavin, OWNER
Title
Owner
Phone
(252) 456-9996

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X MHL-093-055 NC Primary

Addresses

Primary practice location

426 Rooker Dairy Rd
Norlina, NC 27563-9544

Mailing address

545 Rooker Dairy Rd
Norlina, NC 27563-9545
Phone (252) 456-2998

Other identifiers 1

IdentifierTypeStateIssuer
7805804MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Gavin Downey Heavenly Living Home 13 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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": "1276214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276214400000",
    "number": "1689994709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 ROOKER DAIRY RD",
            "city": "NORLINA",
            "state": "NC",
            "postal_code": "275639545",
            "telephone_number": "252-456-2998",
            "fax_number": "252-456-2027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "426 ROOKER DAIRY RD",
            "city": "NORLINA",
            "state": "NC",
            "postal_code": "275639544",
            "telephone_number": "252-456-9996",
            "fax_number": "252-456-2027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAVIN & DOWNEY HEAVENLY LIVING HOME #3",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-11",
        "last_updated": "2010-06-11",
        "status": "A",
        "authorized_official_last_name": "GAVIN",
        "authorized_official_first_name": "ANN",
        "authorized_official_middle_name": "LOIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-456-9996",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "MHL-093-055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805804",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norlina, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2010; 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.