Senior Citizens Home Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH0477 Issued in NC

Legal business name

SENIOR CITIZENS HOME INC

Practice address

2275 Ruin Creek Rd
Henderson, NC 27537-8732

Phone

(252) 492-0066

NPI assigned

Oct 11, 2005

Last updated

Jun 19, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Herman Davis III

Title

Administrator

Phone

(252) 492-0066

Specialties & licenses 3

Addresses

Other identifiers 3

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Woodlawn Retirement Home

  • Assisted Living Facility
  • Henderson, NC
  • NPI 1043241748
  NPPES parent name

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1740278126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2275 RUIN CREEK RD",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275378732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2275 RUIN CREEK RD",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275378732",
            "telephone_number": "252-492-0066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR CITIZENS HOME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-11",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "HERMAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "252-492-0066",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "NH0477",
            "primary": false
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NC",
            "license": "NH0477",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0477",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3405316",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7801016",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406558",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Walter Jackson Sellers, MA
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• Serenity Resolutions LLC

• Skilled Nursing Facility in Henderson, NC
• Providers in Henderson, NC by specialty
• Skilled Nursing Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 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.