Wellington Park Opco LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

WELLINGTON PARK OPCO LLC

Practice address

329 Cooper Street
Kenansville, NC 28349

Phone

(910) 296-0333

Fax

(910) 296-6101

NPI assigned

Apr 26, 2023

Organization subpart

No

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

Authorized official

Name

Robert Crummie, NC ADMINISTRATOR

Title

Administrator

Phone

(910) 296-0333

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1682467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682467200000",
    "number": "1780372987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "329 COOPER STREET",
            "city": "KENANSVILLE",
            "state": "NC",
            "postal_code": "28349",
            "telephone_number": "910-296-0333",
            "fax_number": "910-296-6101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "329 COOPER STREET",
            "city": "KENANSVILLE",
            "state": "NC",
            "postal_code": "28349",
            "telephone_number": "910-296-0333",
            "fax_number": "910-296-6101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLINGTON PARK OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-26",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-18",
        "status": "A",
        "authorized_official_last_name": "CRUMMIE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "910-296-0333",
        "authorized_official_credential": "NC ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clarence Hughes Wagoner Jr., CRNA
• Rebecca Hinds Ward, RN
• Wayne Pharmacy, Inc.
• Dieter Tetatah Wefuan, M.D.
• Amber Weifenbach
• Jennifer Wilson
• Luke Allan Yeager, MD
• James Austin Yoder, M.D.
• Eric Morgan Yopp, OD

• Assisted Living Facility in Kenansville, NC
• Providers in Kenansville, 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 Apr 26, 2023; 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.