NPIMap

Organization Active NPI

Cornelia Nixon Davis, Inc.

Doing business as Champions Assisted Living

  • Assisted Living Facility
  • Wilmington, NC
National Provider Identifier
1851396535
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
HAL065020 Issued in NC
Legal business name
CORNELIA NIXON DAVIS, INC.
Doing business as
Champions Assisted Living
Practice address
1007 Porters Neck Rd
Wilmington, NC 28411-7383
Phone
(910) 686-6462
Fax
(910) 686-8320
NPI assigned
Jun 17, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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
Phone
(910) 686-7195

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X HAL065020 NC Primary

Addresses

Primary practice location

1007 Porters Neck Rd
Wilmington, NC 28411-7383

Mailing address

1007 Porters Neck Rd
Wilmington, NC 28411-7383
Phone (910) 686-6462

Other identifiers 1

IdentifierTypeStateIssuer
7804910MedicaidNC

Other names 1

  • Champions Assisted Living Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D1104278Champions Assisted Living1007 Porters Neck Rd, Wilmington, NC 28411Certificate of waiverAug 27, 2027

National Provider Directory

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

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851396535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 PORTERS NECK RD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284117383",
            "telephone_number": "910-686-6462",
            "fax_number": "910-686-8320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 PORTERS NECK RD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284117383",
            "telephone_number": "910-686-6462",
            "fax_number": "910-686-8320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNELIA NIXON DAVIS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "910-686-7195",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL065020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804910",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Champions Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilmington, NC

Sources for this page

  • 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.
  • 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.