Avante at Reidsville, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH0293 Issued in NC

Legal business name

AVANTE AT REIDSVILLE, INC.

Practice address

543 Maple Ave
Reidsville, NC 27320-4627

Phone

(336) 342-1382

Fax

(336) 616-0868

NPI assigned

Oct 26, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Lisa Wilson

Title

President

Phone

(954) 987-7180

Specialties & licenses 2

Addresses

Other identifiers 2

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479081600000",
    "number": "1780769711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 SHERIDAN STREET",
            "address_2": "SUITE 500",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330213439",
            "telephone_number": "336-342-1382",
            "fax_number": "336-496-4080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "543 MAPLE AVE",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273204627",
            "telephone_number": "336-342-1382",
            "fax_number": "336-616-0868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVANTE AT REIDSVILLE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2016-11-14",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-987-7180",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NC",
            "license": "NH0293",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3435227",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3436230",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2016; 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.