NPIMap

Organization Active NPI

Cornelia Nixon Davis, Inc.

Doing business as Davis Health and Wellness at Cambridge Village

  • Skilled Nursing Facility
  • Wilmington, NC
National Provider Identifier
1841697422
Registry record updated Sep 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH0645 Issued in NC
Legal business name
CORNELIA NIXON DAVIS, INC.
Doing business as
Davis Health and Wellness at Cambridge Village
Practice address
83 Cavalier Dr.
200
Wilmington, NC 28405-4444
Phone
(910) 319-2111
Fax
(910) 686-7592
NPI assigned
Nov 26, 2014
Last updated
Sep 14, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
CORNELIA NIXON DAVIS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 14, 2018

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

Authorized official

Name
Mr. Charles Allen Long
Title
Executive Director (Ceo)
Phone
(910) 686-7195

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NH0645 NC Primary

Addresses

Primary practice location

83 Cavalier Dr.
200
Wilmington, NC 28405-4444

Mailing address

1011 Porters Neck Rd
Wilmington, NC 28411-9196
Phone (910) 319-2111

Other identifiers 1

IdentifierTypeStateIssuer
3405568MedicaidNC

Other names 1

  • Davis Health and Wellness at Cambridge Village Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150402002136 NC Part A Provider - Skilled Nursing Facility 3870482581 Practice locations: Wilmington, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841697422. Details of each certification follow.

Skilled nursing facility certification: CCN 345568

Legal name
CORNELIA NIXON DAVIS, INC.
Doing business as
DAVIS HEALTH AND WELLNESS AT CAMBRIDGE VILLAGE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 6, 2015
Last certification
Jan 24, 2025
Beds
20
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1966 in NC
Enrollment address
83 Cavalier Drive
Suite 200
Wilmington, NC 28405
Nursing home name
DAVIS HEALTH AND WELLNESS CENTER AT CAMBRIDGE VILLAGE

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Davis Health and Wellness Center at Cambridge VillCCN 345568 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jun 6, 2015
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
2016.6 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Cornelia Nixon Davis Inc4 organizations share this tax ID, including this one
Part of
Cornelia Nixon Davis Inc

Other organizations with this tax ID 3

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

Locations

75 Cavalier Dr
Wilmington, NC 28405
Phone (910) 239-9500

83 Cavalier Dr
Ste 200
Wilmington, NC 28405
Phone (910) 319-2111

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mary Clements Individual Operational/Managerial Control Aug 16, 2024
Adp of the SNF Aug 16, 2024
Cornelia Nixon Davis, Inc. Organization, Wilmington, NC Corporation, Medical provider/supplier Operational/Managerial Control May 6, 2015
Adp of the SNF May 6, 2015
Eileen Marie Caquias Gonzalez Individual Operational/Managerial Control Jul 1, 2008
Adp of the SNF Jul 1, 2008
Melissa J McAdams Welsh Individual Operational/Managerial Control Aug 13, 2024
Adp of the SNF Aug 13, 2024
Forvis Mazars LLP Organization, Springfield, MO Adp of the SNF Jan 1, 2025
Joanna Biehl Individual Operational/Managerial Control Dec 23, 2024
Adp of the SNF Dec 23, 2024
Unidine Corporation Organization, Charlotte, NC Corporation, Management services company Operational/Managerial Control May 1, 2023
Adp of the SNF May 1, 2023
Charles Long Individual Corporate Officer Jul 1, 2003
Operational/Managerial Control May 6, 2015
Adp of the SNF May 6, 2015

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Davis Health Care CenterWilmington, NC, CCN 345160 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Jul 1, 1966
Jul 1, 1966
Jul 1, 1966

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Cornelia Nixon Davis, Inc.

    dba Davis Health Care Center

    • Skilled Nursing Facility
    • Wilmington, NC
    • NPI 1356346191

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 8

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1416960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536883200000",
    "number": "1841697422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 PORTERS NECK RD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284119196",
            "telephone_number": "910-319-2111",
            "fax_number": "910-686-7592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83 CAVALIER DR.",
            "address_2": "200",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284054444",
            "telephone_number": "910-319-2111",
            "fax_number": "910-686-7592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNELIA NIXON DAVIS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CORNELIA NIXON DAVIS, INC.",
        "enumeration_date": "2014-11-26",
        "last_updated": "2018-09-14",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR (CEO)",
        "authorized_official_telephone_number": "910-686-7195",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0645",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3405568",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Davis Health and Wellness at Cambridge Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.