Jaybird Lse PV05 LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

JAYBIRD LSE PV05 LLC

Practice address

5383 US Highway 117 N
Pikeville, NC 27863-9443

Phone

(919) 242-6369

Fax

(919) 242-6370

NPI assigned

Jan 7, 2025

Organization subpart

No

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

Authorized official

Name

Danielle Smith

Title

Director

Phone

(919) 242-6369

Specialties & licenses 1

Addresses

Other names 1

• The Indigo at Pikeville Doing business as

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

{
    "created_epoch": "1736208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736208000000",
    "number": "1831908441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5383 US HIGHWAY 117 N",
            "city": "PIKEVILLE",
            "state": "NC",
            "postal_code": "278639443",
            "telephone_number": "919-242-6369",
            "fax_number": "919-242-6370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5383 US HIGHWAY 117 N",
            "city": "PIKEVILLE",
            "state": "NC",
            "postal_code": "278639443",
            "telephone_number": "919-242-6369",
            "fax_number": "919-242-6370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAYBIRD LSE PV05 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-07",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "919-242-6369"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Indigo at Pikeville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amber Brooke Foss, FNP
• Kelly Ann Hammerbeck, NP-C
• Connie C Hargrove, CPSS
• Sydney Ball Holmes
• Jodie Hudson, R.PH.
• Keke Komeko Johnson, CADC
• Michele Kibler
• Elizabeth Murray King, MS, LCAS
• Krystal'S House, Inc
• Krystals House, LLC

• All providers in Pikeville, NC
• Assisted Living Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2025; 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.