Cmba LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

HAL034-080 Issued in NC

Legal business name

CMBA LLC

Doing business as

Brookstone Terrace

Practice address

4430 Clinard Rd
Clemmons, NC 27012-8487

Phone

(336) 766-5000

NPI assigned

Mar 11, 2008

Organization subpart

No

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

Authorized official

Name

Ms. Sherry L Dube

Title

Director

Phone

(336) 766-5000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Brookstone Terrace Doing business as

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

{
    "created_epoch": "1205193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205193600000",
    "number": "1730359357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1682",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270121682",
            "telephone_number": "336-766-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4430 CLINARD RD",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128487",
            "telephone_number": "336-766-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CMBA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-11",
        "last_updated": "2008-03-11",
        "status": "A",
        "authorized_official_last_name": "DUBE",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "336-766-5000",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL034-080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7803623",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookstone Terrace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Clemmons, NC
• Providers in Clemmons, NC by specialty
• Assisted Living Facility in North Carolina

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

Verify at the official NPI Registry.