Camelot Manor Inc
Organization Active NPI Assisted Living Facility · Granite Falls, NC
NPI 1720188915 · NPPES record last updated Jul 15, 2008
Key facts
- NPI
- 1720188915
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Assisted Living Facility 310400000X
- License
- HAL-014-014 (NC)
- Legal business name
- CAMELOT MANOR INC
- Practice address
- 56 N Highland Ave
Dba Brockford Inn Inc
Granite Falls, NC 28630-1205 - Phone
- (828) 396-3111
- Fax
- (828) 396-5822
- NPI assigned
- Sep 25, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Judith Barlow
- Title
- Administrator/ Owner
- Phone
- (828) 396-3111
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2017744 | Brockford Inn Assisted Living | Certificate of waiver | Dec 16, 2026 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | HAL-014-014 | NC | Yes |
| Alzheimer Center (Dementia Center) | 311500000X | HAL-014-014 | NC |
Addresses
Primary practice location
56 N Highland Ave
Dba Brockford Inn Inc
Granite Falls, NC 28630-1205
Mailing address
PO Box 58
Dba Brockford Inn Inc
Granite Falls, NC 28630-0058
Phone (828) 396-3111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7805030 | Medicaid | NC | |
| 600480534 | Other | NC | STATE NUMBER |
Other names
- DBA Brockford Inn Inc
Other providers in Granite Falls, NC
- Caldwell Memorial Hospital, Inc
- Caldwell Memorial Hospital, Inc
- Caldwell Memorial Hospital, Inc.
- Elizabeth Caldwell
- Wendy Calloway
- Camelot Manor Nursing Care Facility Inc
- Camelot Manor Nursing Care Facility, Inc
- Anne Luckadoo Cannon
- Catawba Valley Resource LLC
- Annette Chontos
All providers in Granite Falls, NC · Assisted Living Facility in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.