Edenton Retirement Community, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EDENTON RETIREMENT COMMUNITY, LLC

Practice address

106 Mark Dr
Edenton, NC 27932-1756

Phone

(252) 482-4491

NPI assigned

Apr 8, 2010

Organization subpart

No

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

Authorized official

Name

Mr. David Dean Wilson

Title

Managing Partner

Phone

(336) 495-2700

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1270684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371081600000",
    "number": "1790001246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 814",
            "city": "RANDLEMAN",
            "state": "NC",
            "postal_code": "273170814",
            "telephone_number": "336-495-2700",
            "fax_number": "336-495-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 MARK DR",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279321756",
            "telephone_number": "252-482-4491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDENTON RETIREMENT COMMUNITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-08",
        "last_updated": "2013-06-13",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "336-495-2700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "HAL-021-008",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7806302",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Sarah Elliott

• 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 Jun 13, 2013; 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.