Active NPI
Irene Small
- Assisted Living Facility
- Henderson, NC
National Provider Identifier
1710158993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- License
- FCL091008
- Practice address
- 1421 Ross Mill Rd
Henderson, NC 27537-5965 - Phone
- (252) 492-2316
- NPI assigned
- Mar 17, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | FCL091008 | NC | Primary |
Addresses
Primary practice location
1421 Ross Mill Rd
Henderson, NC 27537-5965
Mailing address
1421 Ross Mill Road
Henderson, NC 27537
Phone (252) 492-2316
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7803224 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| FCL091008 | NC | MD | Assisted Living Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212019200000",
"number": "1710158993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1421 ROSS MILL ROAD",
"city": "HENDERSON",
"state": "NC",
"postal_code": "27537",
"telephone_number": "252-492-2316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1421 ROSS MILL RD",
"city": "HENDERSON",
"state": "NC",
"postal_code": "275375965",
"telephone_number": "252-492-2316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMALL",
"first_name": "IRENE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-03-17",
"last_updated": "2008-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "NC",
"license": "FCL091008",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7803224",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.