Active NPI
Alamance Extended Care, Inc.
- Skilled Nursing Facility
- Burlington, NC
National Provider Identifier
1750418802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- NH0596
- Legal business name
- ALAMANCE EXTENDED CARE, INC.
- Practice address
- 1860 Brookwood Ave
Burlington, NC 27215-3200 - Phone
- (336) 570-8456
- Fax
- (336) 570-8460
- NPI assigned
- Feb 27, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. James Michael Benton
- Title
- Cfo
- Phone
- (336) 570-8458
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | NH0596 | NC | Primary |
Addresses
Primary practice location
1860 Brookwood Ave
Burlington, NC 27215-3200
Mailing address
1860 Brookwood Ave
Burlington, NC 27215-3200
Phone (336) 570-8456
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0015735 | Medicaid | NC | |
| 39746 | Other | NC | PARTNERS MEDICARE CHOICE |
| 7805329 | Medicaid | NC | |
| 00826 | Other | NC | BLUE CROSS BLUE SHIELD |
| 3416590 | Medicaid | NC | |
| 3415091 | Medicaid | NC | |
| 7100024 | Other | NC | UNITED HEALTHCARE MEDICAR |
Other names 1
- Edgewood Place at the Village at Brookwood
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050401000675 | NC | Part A Provider - Skilled Nursing Facility | 4183671126 | Practice locations: Burlington, NC |
Skilled nursing facility certification: CCN 345091
- Legal name
- ALAMANCE EXTENDED CARE, INC.
- Doing business as
- EDGEWOOD PLACE AT THE VILLAGE AT BROOKWOOD
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- May 1, 1973
- Last certification
- May 10, 2024
- Beds
- 75 (51 certified)
- Ownership / control type
- Nonprofit Corporation
- Multi-facility organization
- kintura
- Organization structure
- Corporation
- Incorporated
- Jan 1, 2001 in NC
- Enrollment address
- 1820 Brookwood Avenue
Burlington, NC 27215-3200 - Nursing home name
- EDGEWOOD PLACE AT THE VILLAGE AT BROOKWOOD
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Edgewood Place at the Village at Brookwood
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- May 1, 1973
- Medicare certification status
- Active
- Certified beds
- 51
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D0881486 | Alamance Extended Care Dba the Village | Certificate of waiver | Jan 10, 2028 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 3
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Alan Tutterow | Corporate Officer | Jul 1, 1993 | |
| April Mayberry | Operational/Managerial Control | Sep 3, 2019 | |
| Well Spring Retirement Community | 5% Or Greater Direct Ownership Interest | Jul 1, 2022 | 100% |
Practitioners & affiliated clinicians
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1750418802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1860 BROOKWOOD AVE",
"city": "BURLINGTON",
"state": "NC",
"postal_code": "272153200",
"telephone_number": "336-570-8456",
"fax_number": "336-570-8460"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1860 BROOKWOOD AVE",
"city": "BURLINGTON",
"state": "NC",
"postal_code": "272153200",
"telephone_number": "336-570-8456",
"fax_number": "336-570-8460"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ALAMANCE EXTENDED CARE, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-27",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "BENTON",
"authorized_official_first_name": "JAMES",
"authorized_official_middle_name": "MICHAEL",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "336-570-8458",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NC",
"license": "NH0596",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0015735",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PARTNERS MEDICARE CHOICE",
"identifier": "39746",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7805329",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "00826",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3416590",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3415091",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE MEDICAR",
"identifier": "7100024",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Edgewood Place at the Village at Brookwood",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Burlington, NC
Sources for this page
- 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.