Jefferson Family Care Home #4

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

JEFFERSON FAMILY CARE HOME #4

Practice address

181 Staley Boswell Rd
Yanceyville, NC 27379-8386

Phone

(336) 421-9468

Fax

(336) 421-5726

NPI assigned

Mar 29, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Melinda Jefferson

Title

Owner

Phone

(336) 421-9468

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Jefferson Care Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Jefferson Care Home

  • Adult Care Home Facility
  • Yanceyville, NC
  • NPI 1295854933
  NPD tax ID

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1841319746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "181 STALEY BOSWELL RD",
            "city": "YANCEYVILLE",
            "state": "NC",
            "postal_code": "273798386",
            "telephone_number": "336-421-9468",
            "fax_number": "336-421-5726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181 STALEY BOSWELL RD",
            "city": "YANCEYVILLE",
            "state": "NC",
            "postal_code": "273798386",
            "telephone_number": "336-421-9468",
            "fax_number": "336-421-5726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON FAMILY CARE HOME #4",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JEFFERSON",
        "authorized_official_first_name": "MELINDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-421-9468",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7802011",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hearthstone Youth and Family Services, Inc.
• Katie Sims Hernandez, DO
• Grant Hitchens, PT, DPT
• Denise N Hunter, MD
• Jefferson Care Home
• Aimee Jenkins, LCSW
• Vineetha Joelin, NP-C
• Melissa Massengill Jones, PHARMD
• Philip Jones, DPT
• Nicole Joyner-Powell, DO

• Adult Care Home Facility in Yanceyville, NC
• Providers in Yanceyville, 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 Aug 22, 2020; 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.