NPIMap

Organization Active NPI

Lutheran Family Services in the Carolinas

  • Intellectual Disabilities Intermediate Care Facility
  • Winston Salem, NC
National Provider Identifier
1881740298
Registry record updated Jun 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
MHL034045 Issued in NC
Legal business name
LUTHERAN FAMILY SERVICES IN THE CAROLINAS
Doing business as
Wilson Smith Cottage
Practice address
185 Martindale Rd
Winston Salem, NC 27107-1705
Phone
(336) 785-3813
NPI assigned
Jan 26, 2007
Organization subpart
Yes
Parent organization
LUTHERAN FAMILY SERVICES IN THE CAROLINASAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 26, 2017

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

Authorized official

Name
Mr. Kirby Nickerson
Title
Chief Financial Officer
Phone
(704) 754-8228

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Intellectual Disabilities Intermediate Care Facility 315P00000X MHL034045 NC Primary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL-034-045 NC

Addresses

Primary practice location

185 Martindale Rd
Winston Salem, NC 27107-1705

Mailing address

PO Box 2369
Salisbury, NC 28145-2369
Phone (704) 754-8232

Other identifiers 1

IdentifierTypeStateIssuer
3406387MedicaidNC

Other names 1

  • Wilson Smith Cottage Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 34G204

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
WILSON SMITH COTTAGE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Aug 20, 1991
Last certification
May 14, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
185 Martindale Rd
Winston Salem, NC 27107

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
34D2124587Wilson Smith Cottage185 Martindale Road, Winston-Salem, NC 27107Certificate of waiverJan 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
Lutheran Counseling Cen29 organizations share this tax ID, including this one
Part of
Lutheran Counseling Cen

Other organizations with this tax ID 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498435200000",
    "number": "1881740298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2369",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281452369",
            "telephone_number": "704-754-8232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 MARTINDALE RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271071705",
            "telephone_number": "336-785-3813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN FAMILY SERVICES IN THE CAROLINAS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LUTHERAN FAMILY SERVICES IN THE CAROLINAS",
        "enumeration_date": "2007-01-26",
        "last_updated": "2017-06-26",
        "status": "A",
        "authorized_official_last_name": "NICKERSON",
        "authorized_official_first_name": "KIRBY",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "704-754-8228",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": "MHL034045",
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-034-045",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406387",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wilson Smith Cottage",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.