Mocksville Opco, LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

MOCKSVILLE OPCO, LLC

Doing business as

Mocksville Senior Living and Memory Care

Practice address

337 Hospital St
Mocksville, NC 27028-2060

Phone

(336) 751-2175

Fax

(336) 751-0136

NPI assigned

Apr 19, 2017

Organization subpart

No

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

Authorized official

Name

Charles E Trefzger

Title

Manager

Phone

(828) 322-5535

Specialties & licenses 3

Addresses

Other names 1

• Mocksville Senior Living and Memory Care Doing business as

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

CLIA laboratory certificates

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

{
    "created_epoch": "1492560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635811200000",
    "number": "1811421456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "337 HOSPITAL ST",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "270282060",
            "telephone_number": "336-751-2175",
            "fax_number": "336-751-0136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "337 HOSPITAL ST",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "270282060",
            "telephone_number": "336-751-2175",
            "fax_number": "336-751-0136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOCKSVILLE OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-19",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "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"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL030009",
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mocksville Senior Living and Memory Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mocksville Senior Living and Memory Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alison L McNeil, PA
• Paul Diamond Mighion, D.D.S.
• Joy N Miller-Kyle, LCASA LPCA
• Marian Miller
• Heather Mitchell
• Monarch
• Holly Moody, MS, OTR/L
• Loretta Morris, RMA/CMA, CNA, MT
• Seavon Munoz, DO
• N. Kephart DDS PLLC

• Adult Care Home Facility in Mocksville, NC
• Providers in Mocksville, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; 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.