Shelby Manor Group Home

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

HAL023008 Issued in NC

Legal business name

SHELBY MANOR GROUP HOME

Practice address

1176 Wyke Rd
Shelby, NC 28150-4273

Phone

(276) 628-5000

Fax

(276) 623-2148

NPI assigned

Jan 9, 2007

Last updated

Aug 22, 2020By 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. Dennis R. Owens

Title

Executive Vice President

Phone

(276) 628-5000

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740339126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 ABINGDON PL",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242116122",
            "telephone_number": "276-628-5000",
            "fax_number": "276-623-2148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1176 WYKE RD",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281504273",
            "telephone_number": "276-628-5000",
            "fax_number": "276-623-2148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELBY MANOR GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OWENS",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "276-628-5000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "HAL023008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7803639",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelby Eye Centers, P.a.
• Shelby Family Practice
• Shelby House LLC (Cleveland House)
• Shelby Internal Medicine, Inc
• Shelby Manor
• Shelby Medical Associates PA
• Shelby Medical Associates, P.a.
• Shelby Medical Associates, PA
• Shelby Opco, LLC (Shelby Manor)
• Shelby Pathology Group PA

• Adult Care Home Facility in Shelby, NC
• Providers in Shelby, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.