Life St. Joseph of the Pines, Inc.

Primary specialty

PACE Provider OrganizationTaxonomy code 251T00000X

License

PENDING Issued in NC

Legal business name

LIFE ST. JOSEPH OF THE PINES, INC.

Practice address

4900 Raeford Rd
Fayetteville, NC 28304-3142

Phone

(910) 483-4911

NPI assigned

Jun 25, 2010

Last updated

Feb 8, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

ST JOSEPH OF THE PINESAs reported in NPPES

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

Authorized official

Name

Mr. Robert Lawrence Dickson

Title

Executive Director

Phone

(910) 429-7255

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

St Joseph of the Pines Inc

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• St. Joseph of the Pines, Inc

  • Skilled Nursing Facility
  • Southern Pines, NC
  • NPI 1184712580
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tara R Jones

  • Family Medicine Physician
  • Fayetteville, NC
  • NPI 1063705119
  NPD (past)

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

{
    "created_epoch": "1277424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360281600000",
    "number": "1750692620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 RAEFORD RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043142",
            "telephone_number": "910-483-4911",
            "fax_number": "910-483-4930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 RAEFORD RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043142",
            "telephone_number": "910-483-4911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE ST. JOSEPH OF THE PINES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST JOSEPH OF THE PINES",
        "enumeration_date": "2010-06-25",
        "last_updated": "2013-02-08",
        "status": "A",
        "authorized_official_last_name": "DICKSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "910-429-7255",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": "NC",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• PACE Provider Organization in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• PACE Provider Organization in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.

Verify at the official NPI Registry.