Edenton House, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

HAL-021-006 Issued in NC

Legal business name

EDENTON HOUSE, LLC

Practice address

323 Medical Arts Drive
Edenton, NC 27932

Phone

(252) 482-1113

NPI assigned

Jul 19, 2007

Last updated

Oct 15, 2007By 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. Charles E Trefzger Jr.

Title

Manager

Phone

(828) 322-5535

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Edenton House Other name

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192406400000",
    "number": "1760682579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1978 8TH AVE NW",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286013312",
            "telephone_number": "828-322-5535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 MEDICAL ARTS DRIVE",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "27932",
            "telephone_number": "252-482-1113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDENTON HOUSE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-19",
        "last_updated": "2007-10-15",
        "status": "A",
        "authorized_official_last_name": "TREFZGER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "828-322-5535",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL-021-006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805865",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edenton House",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Edenton Urology Clinic

• Assisted Living Facility in Edenton, NC
• Providers in Edenton, 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 Oct 15, 2007; 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.